Gout: allopurinol tied to lower risk for advanced CKD

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Takeaway

  • Allopurinol use of at least 300 mg/day for incident gout is associated with a 13% lower risk for stage ≥3 chronic kidney disease (CKD).
  • Lower doses of allopurinol do not show this benefit.

Why this matters

  • An invited commentary observes: "allopurinol is unlikely to contribute to progression of CKD; indeed, it might even be protective, presumably by reducing the risk of urate nephropathy."
  • The authors of the study advise that potential causes of CKD other than allopurinol be investigated in patients with gout with renal function decline.

Study design

  • Population-based, prospective cohort study (n=9520) of newly diagnosed patients with gout started on allopurinol at ≥300 mg/day (n=4760) or not on allopurinol (nonusers; n=4760) in a UK general practitioner medical records database.
  • Patients were excluded if they had prior urate-lowering therapy (allopurinol, febuxostat, probenecid, sulfinpyrazone) or CKD stage 3 or higher.
  • Funding: NIH; Ministry of Science, Technology and Innovation of Brazil.

Key results

  • Fewer allopurinol users (vs nonusers) developed stage ≥3 CKD (579 vs 623); mean follow-up was 4-5 years.
  • Allopurinol use was associated with a 13% decline in stage ≥3 CKD in propensity-matched analysis (HR, 0.87; 95% CI, 0.77-0.97).
  • No benefit seen at lower doses of allopurinol.

Limitations

  • Potential selection bias.
  • Observational design.