We explored the therapeutic efficacy and tolerability of dotinurad, a selective inhibitor of urate reabsorption, among hyperuricemic subjects suffering from advanced chronic kidney disease (CKD) (classified as stage G3-5). A retrospective evaluation was performed on the records of 34 individuals (mean age, 68.6 ± 13.3 years; 17 male and 17 female) after a 12-month course of dotinurad, focusing on alterations in uric acid (UA) and the urine protein-to-creatinine ratio (UPCR), alongside the yearly rate of change in estimated glomerular filtration rate (eGFR). Each patient presented with hyperuricemia (UA ≥ 6.0 mg/dL) and advanced CKD (average eGFR: 32.0 ± 13.3 mL/min/1.73m²; stage G3, n = 17; G4, n = 13; G5, n = 4). A comparator arm was formed from the records of 34 propensity-score-matched counterparts who were not prescribed dotinurad. Serum UA concentrations fell markedly within the dotinurad-treated group (7.1 ± 0.8 mg/dL to 5.9 ± 1.0 mg/dL, P < 0.05), while remaining static in the matched controls. The UPCR did not vary appreciably between the two cohorts. A substantial reduction in low-density lipoprotein cholesterol was also registered in the dotinurad arm (98.8 ± 43.4 mg/dL to 82.9 ± 33.1 mg/dL, P < 0.05). After 12 months of dotinurad administration, the yearly eGFR slope improved significantly, from −6.0 ± 12.9 mL/min/1.73 m²/year to −0.9 ± 4.6 mL/min/1.73 m²/year (P < 0.05); the control group showed no comparable shift. Dotinurad is capable of diminishing UA levels and could mitigate the loss of kidney function in patients burdened by both hyperuricemia and advanced CKD.
