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Acute severe liver dysfunction induced by febuxostat in a patient undergoing hemodialysis

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Abstract

A 58-year-old man with chronic kidney disease (CKD) was admitted to our hospital for hemodialysis (HD) therapy. He had been administered allopurinol (100 mg/day) before hospitalization, and we replaced it with febuxostat (10 mg/day), a new xanthine oxidase inhibitor. Levels of aspartate aminotransferase, alanine transaminase (ALT), and lactate dehydrogenase were within the normal ranges in the morning before febuxostat administration, but 6 h after administration, these parameters increased markedly to approximately 10 times the levels before administration. Although we stopped administering febuxostat, his serum potassium levels increased at a rate of 1 mmol/L every 12 h, and he had to undergo HD daily to lower the serum potassium levels. The levels of liver function test parameters peaked on the fourth hospital day (ALT, 1134 IU/L; AST, 1485 IU/L; and LDH, 1869 IU/L) and recovered to normal ranges on the 13th hospital day. In this case, febuxostat appeared to have a relationship with acute liver dysfunction in the clinical course. Therefore, it would be important to check liver function test parameters frequently after febuxostat initiation and also to initiate a lower than usual dose of febuxostat, especially in patients with CKD and those who are undergoing HD.

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Acknowledgments

We thank Teijin Pharma Ltd. for measuring serum febuxostat concentrations as a part of the investigation into the causes of the adverse effects. A part of this case was presented at the 57th Annual Meeting of the Japanese Society for Dialysis Therapy.

Conflict of interest

The authors have declared that no conflict of interest exists.

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Authors and Affiliations

  1. Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Kiyonori Ito, Yuichiro Ueda, Haruhisa Miyazawa, Yoshio Kaku, Keiji Hirai, Taro Hoshino, Aoi Nabata, Honami Mori, Izumi Yoshida, Susumu Ookawara & Kaoru Tabei

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  1. Kiyonori Ito
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  2. Yuichiro Ueda
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  3. Haruhisa Miyazawa
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  4. Yoshio Kaku
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  5. Keiji Hirai
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  6. Taro Hoshino
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  7. Aoi Nabata
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  8. Honami Mori
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  9. Izumi Yoshida
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  10. Susumu Ookawara
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  11. Kaoru Tabei
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Correspondence to Kiyonori Ito.

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Ito, K., Ueda, Y., Miyazawa, H. et al. Acute severe liver dysfunction induced by febuxostat in a patient undergoing hemodialysis. CEN Case Rep 3, 158–161 (2014). https://doi.org/10.1007/s13730-014-0109-2

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  • DOI: https://doi.org/10.1007/s13730-014-0109-2

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