medwireNews: Allopurinol, given at a starting dose of at least 300 mg/day, does not increase the risk for chronic kidney disease (CKD) stage 3 or higher, and may in fact reduce it, in patients with newly diagnosed gout, study data show.
“These findings in the context of the existing body of literature, including the recent demonstration of safe allopurinol dose escalation in patients with gout and CKD, indicate that allopurinol was not associated with poor renal function in patients with gout,” Tuhina Neogi (Boston University School of Medicine, Massachusetts, USA) and colleagues remark.
The researchers found that 12.2% of 4760 adults (83.5% men) with gout who initiated allopurinol (≥300 mg/day) between 2000 and 2014 developed CKD stage 3 or higher during a mean 5 years of follow-up.
This compared with a rate of 13.1% in 4760 adults (83.4% men) with newly diagnosed gout who did not receive allopurinol but were propensity matched to the treatment cohort for a number of potential confounders including gout duration, baseline serum urate, baseline kidney function, baseline albuminuria, and comorbidity.
Among both groups, the mean baseline age was 57 years, mean baseline BMI was 30 kg/m2, and mean baseline estimated glomerular filtration rate was 77 mL/min per 1.73 m2, indicating that all participants initiated the study with normal or near normal kidney function.
Cox proportional hazards analysis showed that use of allopurinol at a dose of least 300 mg/day was associated with a significant 13% lower risk for developing CKD stage 3 or higher compared with no use.
The researchers also conducted a sensitivity analysis using data for 10,179 patients who initiated allopurinol at a dose of less than 300 mg/day and the same number of matched non-initiators. They found that, at this lower dose, allopurinol had no significant association with renal function decline.
Writing in JAMA Internal Medicine, Neogi and co-authors say that their study “is one of few that have evaluated the relation of allopurinol to renal function among patients with gout and normal or near-normal kidney function at baseline.”
They conclude: “Because allopurinol did not appear to be associated with renal function decline, clinicians should consider evaluating other factors when faced with renal function decline in their patients with gout rather than lowering the dose of or discontinuing allopurinol, a strategy that has contributed to the ongoing suboptimal treatment of gout.”
By Laura Cowen
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