Friday, 21 Sep 2018

You are here

Allopurinol Dose Escalation is Safe with Severe CKD

Hypertension, nephrolithiasis and chronic kidney disease (CKD) commonly associates with gout.  While there is a clear need to dose adjust NSAIDs and colchicine in those with CKD, there is some debate about the need to dose adjust when using allopurinol with CKD.

Stamp and coworkers from Auckland did a post-hoc analysis of a 24-month allopurinol dose escalation treat-to-target randomized controlled trial to study the effect of baseline kidney function on safety and efficacy of allopurinol dose escalation to achieve serum urate (SU) <6 mg/dl.

In a trial of 183 gout patients, patients were randomized to either immediate or delayed (by 12 months) allopurinol dose escalation until serum uric acid (SUA) was <6 mg/dl. The effect of baseline kidney function on urate lowering and adverse effects was investigated.

Regardless of baseline creatinine clearance (CrCL) (<30 ml/min;  ≥30 to <60 ml/min; or ≥60 ml/min), the percentage who achieved SUA <6 mg/dl at the final visit was similar, 64.3% vs. 76.4% vs. 75.0%, respectively (p = 0.65).

The mean allopurinol dose at month 24 was significantly lower in those with CrCL <30 ml/min as compared to those with CrCL ≥30 to <60 ml/min or CrCL ≥60 ml/min (250 mg; 365 mg; 460 mg/day, respectively (p < 0.001). Thus, higher doses were needed to achieve target SUA levels in those with normal function and lower doses were needed with renal impairment.

Adverse events (deaths, increased LFTs, change in renal function) were similar among groups.

Allopurinol dose escalation to target SU appears to be safe in people with severe CKD. 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Quarterly Canakinumab Reduces Gout Risk Without Affecting Uric Acid

The Annals of Internal Medicine reports that interleukin-1 (IL-1) inhibitor treatment is associated with a reduced risk of gout attacks - such are the findings of an anlysis of the CANTOS study previously reported at the Annual ACR 2017 meeting in Washington, DC. 

Usual Allopurinol Doses Insufficient in CKD Patients

Uric acid (sUA) control may be a challenge in patients with chronic kidney disease (CKD). A cohort study shows that conventional dosing recommendations for allopurinol are unlikely to reach target serum sUA goals.

Sleep Apnea Raises Gout Risk

Patients with obstructive sleep apnea were at increased risk for incident gout, particularly in the first years after the sleep apnea diagnosis, U.K. researchers reported.

In a large retrospective cohort study, the adjusted hazard ratio for a new gout diagnosis among individuals with sleep apnea was 1.42 (95% CI 1.29-1.56), according to Milica Blagojevic-Bucknall, PhD, of Keele University in Keele, England, and colleagues.

Adherence to Gout Therapies Painfully Low

A retrospective study of the large UK Clinical Practice Research Datalink assessed patient compliance in gout and found that adherence to allopurinol is poor, especially among females and younger patients and those with fewer comorbidities.

Not All Hyperuricemia Leads to Gout

Dalbeth and colleagues studied 4 large prospective cohorts and found that rising levels of serum uric acid (SUA) leads to a non-linear increased risk of incident gout, but only half of those with SUA ≥10mg/dL developed clinically evident gout.