Discussion
CKD, cardiovascular progressionEndothelial dysfunction, vascular damage, Hyperuricemia, atherosclerotic
ADVERSE EVENTS, HYPERURICEMIA, ENDOTHELIAL DYSFUNCTION
In the study, febuxostat at 40 mg daily showed significantly reduced serum uric acid level among patients with CKD stages III to IV and without serious adverse events documented, consistent with a related studyFebuxostat constitutes a nonpurine selective xanthine oxidoreductase inhibitor and a high potency for uric acid lowering agent, but limited studies have addressed the efficacy of febuxostat among patients with advanced CKDObservational studies suggest that uric acid is a potential risk factor for developing CKD and cardiovascular progressionEndothelial dysfunction is an initial phase in the vascular damage and atherosclerotic process. Hyperuricemia and advanced CKD especially in a dialysis population are related to endothelial dysfunction by impairing the nitric oxide bioavailability and markers of endothelial dysfunction are associated with stage of CKDLimitations encountered in this study included a relatively small sample size; one only half of patients were treated with ACEIs or ARBs and only 3.6% of patients were given sodium–glucose cotransporter 2 inhibitors. The observational period of the present study lasted eight weeks which was relatively short to determine renal outcome; thus, further study with a longer follow-up was needed. We had measurement of biomarkers for endothelial dysfunction (serum ADMA, high sensitivity-CRP and ABI measurement) and were unable to longitudinally assess the relationship between changes in endothelial dysfunction and renal function. Therefore, the long term side effects of treatment are needed to be further investigated.