Comparison between the Effects of Allopurinol and Febuxostat on the Survival of Patients on Maintenance Hemodialysis

Abstract

Introduction: There were insufficient pieces of evidence regarding the effect of the two drugs (allopurinol and febuxostat) on patient survival in hemodialysis (HD) patients. Herein, we aimed to compare the efficacy of uric acid-lowering drugs (ULDs) or the type of the drug on patient survival using a representative sample of maintenance HD patients in South Korea.

Methods: This study used data from a national HD quality assessment program and the claims data. Use of ULDs was defined as more than one prescription during the 6 months of each HD quality assessment period. The patients were divided into three groups. Patients who were not prescribed allopurinol or febuxostat were included in group 1 (n = 43,251); patients who were prescribed allopurinol were included in group 2 (n = 9,987); and patients who were prescribed febuxostat were included in group 3 (n = 2,890).

Results: Kaplan-Meier curves showed that the survival rate was greatest in group 3 and worst in group 1 among the three groups. Multivariable analysis showed that group 2 had better patient survival compared to group 1; however, there was no significant difference in patient survival between groups 2 and 3. In addition, patients with hyperuricemia or gout had better patient survival compared to those without these diseases.

Conclusions: Our study showed that survival in patients receiving ULDs was not inferior to that of those not receiving ULDs. Patient survival between patients on HD receiving allopurinol and those receiving febuxostat was similar.

Keywords: Allopurinol; Febuxostat; Hemodialysis; Patient survival; Uric acid.

Fig. 1.

Kaplan-Meier curves of patient survival according to groups. a Unweighted data. The 5-year survival rate in groups 1, 2, and 3 was 67.4%, 71.9%, and 76.7%, respectively (p < 0.001). b Weighted data. The 5-year survival rate in groups 1, 2, and 3 was 68.0%, 70.1%, and 72.0%, respectively.

Fig. 2.

Forest plots of the HR and 95% CI according to subgroups. a Univariate Cox regression analysis. b Multivariable Cox regression analysis. Adjustment according to age, sex, underlying disease of end-stage renal disease, Charlson comorbidity index score, hemodialysis vintage, ultrafiltration volume, Kt/V_urea, hemoglobin, serum albumin, serum creatinine, serum phosphorus, serum calcium, systolic blood pressure, diastolic blood pressure, use of antihypertensive drugs, aspirin, statin, or colchicine, and diseases associated with uric acid. CI, confidence interval; DM, diabetes mellitus; HU, hyperuricemia; G1, group 1; G2, group 2; G3, group 3; HR, hazard ratio; Yr, years.