Allopurinol, Febuxostat, and Risk for Renal Disease

Whether elevated uric acid is a result of chronic kidney disease or whether renal function itself is worsened by hyperuricemia has long been debated. Two xanthine oxidase inhibitors, febuxostat (Uloric) and allopurinol, lower uric acid. Febuxostat is more effective in lowering oxidative stress, which theoretically might play a role in renal damage; thus, one hypothesis is that febuxostat provides better renal protection. Researchers compared the two drugs based on claims data from a random 5% sample of new Medicare enrollees (age, ≥65; with no baseline renal disease) who initiated either drug between 2006 and 2012.

Crude rates of renal disease were 192 per 1000 person-years with allopurinol and 338 per 1000 person-years with febuxostat. In v…