Association of CKD with allopurinol use in gout treatment

A research team from the State University of Rio de Janeiro in Brazil and the Boston University School of Medicine in Boston investigated the association of allopurinol use in gout with the risk of developing chronic kidney disease (CKD) stage 3 or higher.

A research team from the State University of Rio de Janeiro in Brazil and the Boston University School of Medicine in Boston investigated the association of allopurinol use in gout with the risk of developing chronic kidney disease (CKD) stage 3 or higher. CKD stage 3 or higher occurs in 20% of patients with gout compared with 5% of those without gout, research shows. The time-stratified propensity score–matched, population-based, prospective cohort study included 4,760 individuals with newly diagnosed gout who initiated allopurinol (300 mg or more per day) and the same number of noninitiators of allopurinol. In all, 579 of the allopurinol initiators developed CKD stage 3 or higher, compared with 623 noninitiators. According to the researchers, use of allopurinol of 300 mg/day or more was linked to a lower risk of developing CKD stage 3 or higher when compared with nonusers. In addition, use of allopurinol at less than 300 mg/d was not associated with renal function decline. "Because allopurinol did not appear to be associated with renal function decline," the authors write, "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."