Urate-lowering therapy for CKD patients with asymptomatic hyperuricemia without proteinuria elucidated by attribute-based research in the FEATHER Study
Authors: Kataoka Hiroshi , Mochizuki Toshio , Ohara Mamiko , Tsuruta Yuki , Iwasa Naomi , Yoshida Rie , Tsuchiya Ken , Nitta Kosaku , Kimura Kenjiro , Hosoya Tatsuo ,   the FEATHER Investigators,   Steering Committee Members, Kimura Kenjiro , Hosoya Tatsuo , Ito Sadayoshi , Inaba Masaaki , Tomino Yasuhiko , Uchida Shunya , Makino Hirofumi , Matsuo Seiichi , Yamanaka Hisashi , Yamamoto Tetsuya ,   Executive Committee Members, Ohno Iwao , Shibagaki Yugo , Iimuro Satoshi , Imai Naohiko , Kuwabara Masanari , Hayakawa Hiroshi ,   Independent Data Monitoring Committee Members, Akizawa Tadao , Teramoto Tamio , Kasanuki Hiroshi , Yoshimura Kenichi ,   Principal Investigators, Kimura Kenjiro , Hosoya Tatsuo ,   Investigators, Shibagaki Yugo , Ohno Iwao , Sato Hiroshi , Uchida Shunya , Horikoshi Satoshi , Maruyama Syoichi , Inaba Masahiko , Moriwaki Yuji , Uchida Haruhito , Kaneshiro Nagayuki , Imai Naohiko , Moriya Hidekazu , Komatsu Yasuhiro , Kaname Shinya , Hanaoka Kazunari , Ogura Makoto , Ikeda Masato , Kasai Kenji , Sugiura Akira , Takahashi Kazushi , Kojima Kenichiro , Nitta Kosaku , Tamai Hirofumi , Nagaya Hiroshi , Okuno Senji , Kakiya Ryusuke , Takeoka Hiroya , Hirata Kyouji , Asano Kenichiro , Fukaya Yasuo , Iwaida Yasushi , Tsuneda Yasuo , Nishimura Shigeaki , Hiramatsu Takeyuki , Isaka Yoshitaka , Ito Takafumi , Yuzawa Yukio , Yamagata Kunihiro , Sofue Tadashi , Jinguji Yoshimi , Hirano Keita , Matsuyama Kazuhiro , Mizumoto Teruhiko , Shibuya Yuko , Sugawara Masahiro , Kadomura Moritoshi , Teshima Yasuaki , Ohtani Hiroshi , Kamata Hiroki , Okawara Susumu , Fukushima Masaki , Takemura Katsumi , Kinugasa Eriko , Kogure Masami , Ehara Yoichi 
Published: March 2022

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.