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Allopurinol use not linked with increased risk for chronic kidney disease
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WASHINGTON — Allopurinol prescription was not associated with an increased risk for deterioration of renal function, according to data presented at the American College of Rheumatology Annual Meeting.
“The majority of people with gout have normal kidney function,” Ana Beatriz Vargas-Santos, in clinical epidemiology research at Boston University School of Medicine, said in her presentation. “And yet, there are emerging data about allopurinol use among people with gout and normal kidney function.”
Santos and colleagues conducted a study in The Health Improvement Network (THIN) — a database of the general population in the United Kingdom. The researchers included patients diagnosed with gout between 2000 and 2014 who had at least one contact with a general practitioner in the year before study entry. Researchers excluded patients with chronic kidney disease (CKD) at stage 3 or more before gout diagnosis. The mean patient age was 58 years. Each allopurinol user was matched with a naïve subject using propensity scores within 1-year cohort accrual blocks.
There were 13,727 allopurinol initiators. Of these, 1,401 developed CKD. Investigators propensity matched allopurinol initiators with 13,727 non-users. Of the non-users, 1,319 developed CKD.
Follow-up began from the date of first allopurinol prescription for those exposed and at a randomly assigned date for the unexposed. Follow-up ended until CKD reached stage 3, death or the end of the study period. The mean follow-up time was 4 years for both groups. Afterward, the researchers determined the association between allopurinol use among patients with gout with the development of CKD to a stage of at least 3. The researchers also performed a sensitivity analysis to censor patients who started or stopped using allopurinol during the study.
Compared with non-users, allopurinol use was not associated with an increased risk of developing CKD at stage 3 or higher. When adjusted for additional cofounders and in the sensitivity analysis, investigators found there was still no association. – by Will Offit
Reference:
Vargas-Santos AB, et al. Abstract #1957. Presented at: American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.
Disclosure: The researchers report no relevant financial disclosures.
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Iris Zink, MSN, RN, ANP-BC
The thought that allopurinol is renal toxic is dated. More awareness of hyperuricemia was present back in the days when all patients had uric acid drawn as it was on the hospital comprehensive panel.
Data from the recent American Society of Nephrology’s Kidney Week highlighted that uric acid itself could be a culprit for kidney disease. “Higher [plasma uric acid] PUA levels are associated with an increased risk for the development [acute kidney injury] AKI in critically ill patients admitted to the ICU, independent of confounding factors, including enrollment, [estimated glomerular filtration rate] eGFR and severity of disease. These results are consistent with a pathogenic role for uric acid in the development of AKI,” according to the study abstract.
We should not fear the treatment for gout, but rather fear what happens to the patients with untreated hyperuricemia. We now know elevated uric acid levels are pro-inflammatory and need to be reduced to reduce mortality.
Reference:
Srivastava A, et al. Poster TH-PO649. Presented at: Kidney Week; Nov. 15-20, 2016; Chicago.
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