Real-world use of dotinurad and one-year prescription presence by kidney function in older adults

Evidence on dotinurad, a selective urate transporter 1 inhibitor, in older adults with reduced kidney function is limited. We conducted a retrospective cohort study using the Japan Medical Data Center elderly claims database from April 2021 to February 2023 to describe real-world dotinurad use, one-year prescription presence, and follow-up kidney function data among adults aged ≥ 75 years who underwent health check-ups with serum creatinine measurement. Among 782,897 eligible individuals, 81,674 (10.4%) received urate-lowering therapy. In the mutually exclusive baseline treatment classification, 840 patients (1.0%) were classified into the dotinurad group, whereas patients prescribed multiple urate-lowering therapies were classified separately as combination therapy users. In drug-specific counts, which included combination therapy, any dotinurad prescription was recorded in 1,094 patients, including 106 with eGFR ≤ 30 mL/min/1.73 m². Across the main eGFR categories from 15 to 30 to 60–90 mL/min/1.73 m², one-year prescription records for dotinurad were observed in 72.9–80.9% of drug-specific baseline users. Among 437 patients in the mutually exclusive dotinurad group with follow-up creatinine measurements, mean eGFR changed from 49.8 to 49.7 mL/min/1.73 m² over one year. These findings describe real-world dotinurad use in older adults, but comparative renal effects cannot be inferred.