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Urate-lowering therapy with allopurinol may not cause kidney damage in patients with gout

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WASHINGTON — No association was reported between allopurinol use and renal dysfunction, according to a presentation at the American College of Rheumatology Annual Meeting.

Ana Beatriz Vargas-Santos, PhD, of the Clinical Epidemiology Research and Training Unit at the Boston University School of Medicine, and colleagues suggested urate-lowering therapy with allopurinol may benefit patients with gout who have renal dysfunction, but that it is unclear whether patients with gout may experience less chronic kidney disease with this drug.

“It is sad to see how many patients with gout are just not treated,” Vargas-Santos said. “It is important to understand that you have to treat the whole disease, not just the flares.”

The study included 13,685 patients who initiated allopurinol between Jan. 1, 2000 and Dec. 31, 2014. The researchers paired these patients with the same number of patients with gout who did not initiate allopurinol. Researchers aimed to determine the relationship between incident allopurinol use and development of chronic kidney disease (CKD) of at least 3.

Results indicated that 1,401 patients in the allopurinol group and 1,319 patients in the non-allopurinol group developed CKD of at least 3. The mean follow-up duration for this was 4 years in both arms of the study. No association was reported between allopurinol and CKD stage of at least 3 (hazard ratio = 0.99).

“About 10% of both groups during a mean follow-up time of 4 years developed CKD of three or above,” Santos said. “This meant there was no risk of harm, but we did not find a beneficial effect.”

This effect remained consisted with further confounders included. A sensitivity analysis also yielded a similar result (hazard ratio = 1.04). The two arms were balanced in terms of covariates, according to Vargas-Santos.

“If a patient with gout using allopurinol starts to show some decline in kidney function, do not reduce the dose. It is better to look for other possible causes,” Vargas-Santos said. “Allopurinol is probably not the cause.” – by Rob Volansky

Reference:

Vargas-Santos, AB, et al. Abstract #1957. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosure: Vargas-Santos reports no relevant financial disclosures.