No Increased Risk of Chronic Kidney Disease with Allopurinol Use Interview with:
Dr. Ana Beatriz Vargas dos Santos
Médica do Serviço de Reumatologia
Universidade do Estado do Rio de Janeiro What is the background for this study?

Response: Gout is the most common inflammatory arthritis worldwide and, despite available treatment, the management of gout remains suboptimal. One of the reasons for this suboptimal management of gout is the hesitant use of urate-lowering therapy, including a common reduction in dose or discontinuation of allopurinol in patients with gout who have kidney dysfunction based on the assumption that allopurinol may be worsening kidney function. However, there is no evidence that allopurinol is toxic for the kidneys, and this dose reduction or discontinuation results in more difficult-to-treat gout.

Chronic kidney disease (CKD) stage 3 or above occurs in approximately 20% of people with gout, and there is emerging evidence that urate-lowering therapy may improve kidney function in patients with both gout and CKD. Although CKD is common, most people with gout start out with normal kidney function. Yet, there are limited data regarding the effects of allopurinol on kidney function in such individuals. We, therefore, undertook this study to assess whether people with newly diagnosed gout who are starting allopurinol are at increased risk for developing CKD stage 3 or worse. What are the main findings?

Response: Allopurinol initiators had the same risk of developing CKD stage 3 or worse compared with non-users during follow-up. What should readers take away from your report?

Response: The main message for clinicians is that allopurinol does not appear to have a harmful effect on kidney function for patients with gout who are starting allopurinol. Therefore, if a patient with gout starts to present a decline in kidney function, clinicians should not stop allopurinol or reduce its dose because it is unlikely that the kidney dysfunction is due to allopurinol. Instead, clinicians should investigate other factors that may be contributing to kidney dysfunction. What recommendations do you have for future research as a result of this study?

Response: A well-conducted randomized placebo-controlled clinical trial is needed to provide definitive insights into the effects of lowering serum urate on kidney function among patients with gout. If a beneficial effect is found, then the next question to address would be whether the mechanisms of action of different urate-lowering drugs makes a difference on this effect on kidney function. For example, the xanthine oxidase inhibitors allopurinol and febuxostat may have additional beneficial effects beyond urate-lowering because they also reduce xanthine oxidase and oxidative stress, whereas uricosuric drugs such as probenecid and lesinurad, or the uricase drug pegloticase would be expected to exert their effects only through lowering serum urate. Thank you for your contribution to the community.

Citation: Abstract presented at 2016 ACR meeting

No Increased Risk of Chronic Kidney Disease with Allopurinol Use
Ana Beatriz Vargas-Santos1, Christine Peloquin2, Yuqing Zhang3 and Tuhina Neogi1, 1Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, 2Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, 3Clinical Epidemiology and Training Unit, Boston University School of Medicine, Boston, MA
Meeting: 2016 ACR/ARHP Annual Meeting
Date of first publication: September 28, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 19, 2016 by Marie Benz MD FAAD