- 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.
- 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.
- 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.
- Potential selection bias.
- Observational design.