Urate-lowering therapy for CKD patients with asymptomatic hyperuricemia without proteinuria elucidated by attribute-based research in the FEATHER Study
Hiroshi Kataoka, Toshio Mochizuki, Mamiko Ohara, Yuki Tsuruta, Naomi Iwasa, Rie Yoshida, Ken Tsuchiya, Kosaku Nitta, Kenjiro Kimura, Tatsuo Hosoya, the FEATHER Investigators, Kenjiro Kimura, Tatsuo Hosoya, Sadayoshi Ito, Masaaki Inaba, Yasuhiko Tomino, Shunya Uchida, Hirofumi Makino, Seiichi Matsuo, Hisashi Yamanaka, Tetsuya Yamamoto, Iwao Ohno, Yugo Shibagaki, Satoshi Iimuro, Naohiko Imai, Masanari Kuwabara, Hiroshi Hayakawa, Tadao Akizawa, Tamio Teramoto, Hiroshi Kasanuki, Kenichi Yoshimura, Principal Investigators, Kenjiro Kimura, Tatsuo Hosoya, Investigators, Yugo Shibagaki, Iwao Ohno, Hiroshi Sato, Shunya Uchida, Satoshi Horikoshi, Syoichi Maruyama, Masahiko Inaba, Yuji Moriwaki, Haruhito A. Uchida, Nagayuki Kaneshiro, Naohiko Imai, Hidekazu Moriya, Yasuhiro Komatsu, Shinya Kaname, K Hanaoka, Makoto Ogura, Masato Ikeda, Kenji Kasai, Akira Sugiura, Kazushi Takahashi, Kenichiro Kojima, Kosaku Nitta, Hirofumi Tamai, Hiroshi Nagaya, Senji Okuno, Ryusuke Kakiya, Hiroya Takeoka, Kyouji Hirata, Kenichiro Asano, Yasuo Fukaya, Yasushi Iwaida, Y Tsuneda, Shigeaki Nishimura, Takeyuki Hiramatsu, Yoshitaka Isaka, Takafumi Ito, Yukio Yuzawa, Kunihiro Yamagata, Tadashi Sofue, Yoshimi Jinguji, Keita Hirano, Kazuhiro Matsuyama, Teruhiko Mizumoto, Yuko Shibuya, Masahiro SUGAWARA, Moritoshi Kadomura, Yasuaki Teshima, Hiroshi Ohtani, Hiroki Kamata, Okawara Susumu, M. Fukushima, Katsumi Takemura, Eriko Kinugasa, Masami Kogure, Y. Ehara
Abstract
Attribute-based medicine is essential for patient-centered medicine. To date, the groups of patients with chronic kidney disease (CKD) requiring urate-lowering therapy are clinically unknown. Herein, we evaluated the efficacy of febuxostat using a cross-classification, attribute-based research approach. We performed post hoc analysis of multicenter, randomized, double-blind, placebo-controlled trial data for 395 patients with stage 3 CKD and asymptomatic hyperuricemia. Participants were divided into febuxostat or placebo groups and subcohorts stratified and cross-classified by proteinuria and serum creatinine concentrations. In patients stratified based on proteinuria, the mean eGFR slopes were significantly higher in the febuxostat group than in the placebo group (P = 0.007) in the subcohort without proteinuria. The interaction between febuxostat treatment and presence of proteinuria in terms of eGFR slope was significant (P for interaction = 0.019). When cross-classified by the presence of proteinuria and serum creatinine level, the mean eGFR slopes significantly differed between the febuxostat and placebo groups (P = 0.040) in cross-classified subcohorts without proteinuria and with serum creatinine level ≥ median, but not in the cross-classified subcohorts with proteinuria and serum creatinine level < median. Febuxostat mitigated the decline in kidney function among stage 3 CKD patients with asymptomatic hyperuricemia without proteinuria.