Gout, allopurinol and chronic kidney disease

Allopurinol does not appear to be associated with kidney function decline, and clinicians should consider other potential contributors when faced with kidney function decline in patients with gout, according to authors of a UK health record database study.

Doctors are often cautious about using allopurinol in patients with gout when renal function declines. However, in the study published in JAMA Internal Medicine (doi.10.1001/jamainternmed.2018.4463), allopurinol did not increase the risk of kidney function decline in patients with gout, and was associated with a 13% lower risk at doses of 300mg or more per day.

579 of the 4760 new gout sufferers given allopurinol (3975 men, 785 women) and 623 of an equivalent number (3971 men, 789 women) not given allopurinol developed chronic kidney disease stage 3 or higher, with a follow-up time of up to five years, mean age of 57 years, and mean body mass index of 30 for both groups. Use of allopurinol of at least 300 mg/day was associated with a lower risk of developing chronic kidney disease stage 3 or higher compared with non-users, with a hazard ratio (HR) of 0.87 (95% CI, 0.77–0.97).

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