American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the key factor in dosing febuxostat for patients with chronic kidney disease?

1. No dose adjustment needed for mild to moderate cases

2. Dose must be halved

3. Must be avoided completely

4. Can only be used in advanced stage

The correct answer is: No dose adjustment needed for mild to moderate cases

In managing chronic kidney disease (CKD) patients, the key factor in dosing febuxostat is that no dose adjustment is needed for mild to moderate cases of CKD. Febuxostat, a xanthine oxidase inhibitor used to treat gout by lowering uric acid levels, is primarily metabolized in the liver. This means that its clearance is largely unaffected in patients with mild to moderate renal impairment. In contrast, patients with advanced CKD may require a different approach, as the potential for accumulation and associated risks might increase, rendering a more cautious use or possible dosage adjustment necessary. However, for the majority of patients with mild to moderate CKD, the standard dosing regimen remains safe and effective without alteration. This ensures that those patients do not experience undue side effects or reduced efficacy from their treatment, thereby maintaining optimal management of their gout condition.