Effect of Dotinurad versus Febuxostat on the One-Year eGFR Slope in CKD Patients with Hyperuricemia: A Retrospective Cohort Study

Background The renoprotective effects of urate-lowering therapy, especially with selective urate reabsorption inhibitors (SURIs), remain to be established in patients with chronic kidney disease (CKD). This study compared changes in the estimated glomerular filtration rate (eGFR) slope associated with the initiation of dotinurad (a SURI) versus febuxostat (a xanthine oxidase inhibitor) in patients with chronic kidney disease, mainly due to diabetic kidney disease or hypertensive nephrosclerosis. Methods We conducted a single-center retrospective cohort study of 81 adult CKD patients with hyperuricemia who were newly started on dotinurad (n = 31) or febuxostat (n = 50) between January 2020 and October 2023. The primary endpoint was the change in the annual eGFR slope in the 1-year period before and after therapy initiation, which was evaluated via a linear mixed-effects model adjusted for baseline differences and confounders. Results According to the multivariable-adjusted analyses, the change in the eGFR slope differed significantly between the two groups (interaction term for group × period × time, p  = 0.048). In the dotinurad group, a declining eGFR trend of − 2.8 mL/min/1.73 m² per year (95% confidence interval [CI] − 6.0 to + 0.4) before treatment stabilized to + 1.4 mL/min/1.73 m² per year (95% CI − 1.0 to + 3.7) after one year of therapy. This within-group change (+ 4.2 mL/min/1.73 m² per year) was statistically significant ( p  = 0.021). No comparable change was observed in the febuxostat group, whose eGFR slope changed from − 0.3 (95% CI − 3.0 to + 2.5) to − 0.8 (95% CI − 2.6 to + 1.0) mL/min/1.73 m² per year (within-group change − 0.5, p  = 0.731). This difference in slopes accounted for the overall difference in treatment effects between the two therapies. The proportion of patients who achieved the target serum uric acid concentration < 6.0 mg/dL at 12 months did not differ significantly between the groups, nor did the incidence of a ≥ 30% decline in the eGFR during follow-up. Conclusions In this CKD cohort predominantly composed of patients with diabetic kidney disease and hypertensive nephrosclerosis, the initiation of dotinurad was associated with a more favorable change in the eGFR slope than febuxostat, suggesting the stabilization of kidney function. These observational findings are hypothesis-generating and warrant confirmation in larger, prospective studies.