Allopurinol treatment for gout appears safe in kidney patients

Reuters Health - 25/01/2022 - For patients with gout and chronic kidney disease (CKD), treatment with allopurinol to achieve a target serum urate (SU) level does not increase the risk of dying, new research indicates.

In a large review of health records, "neither allopurinol initiation, nor achieving target SU level with allopurinol, nor allopurinol dose escalation were associated with an increased risk for death in patients with gout and concurrent CKD," the study team reports in Annals of Internal Medicine.

CKD is a common comorbidity in patients with gout and the cornerstone of gout management is urate-lowering therapy, typically with allopurinol.

"Allopurinol treatment is started at low dose, increased over weeks-months to achieve the target serum urate level, and continued indefinitely," senior author Dr. Yuqing Zhang of Massachusetts General Hospital and Harvard Medical School, in Boston, told Reuters Health by email.

"Two recent randomized control trials and pooled analyses reported that allopurinol was associated with a two-fold increased risk for mortality in patients with renal disease but without gout. These studies raised our concern whether such an effect may also occur among patients with both gout and renal disease," Dr. Zhang explained.

To investigate, the researchers examined data from The Health Improvement Network UK primary-care database on adults with gout and concurrent moderate to severe CKD.

Over five years of follow-up, mortality was significantly lower among 5,277 adults who started allopurinol than among 5,277 propensity-score-matched adults who did not start the drug (4.9 and 5.8 per 100 person-years, respectively; hazard ratio, 0.85; 95% CI, 0.77 to 0.93).

Achieving the target SU level with allopurinol and allopurinol dose escalation were also not associated with increased mortality risk.

"Our findings are clinically relevant in gout care and provide reassurance that allopurinol treatment does not have an apparent detrimental effect on mortality in patients with both gout and renal disease," Dr. Zhang told Reuters Health.

The study had no commercial funding.

SOURCE: https://bit.ly/3FZaA2j Annals of Internal Medicine, online January 24, 2022.

By Megan Brooks



Posted on 25 January, 20228 February, 2022