Usual Allopurinol Doses Insufficient in CKD Patients Save

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.

A Study of 114 CKD (GFR<45 ml) clinic patients had a mean age of 62 years and 46% were female. Nearly half (47%) had a history of gout. The mean cohort sUA level was 7.7 mg/dL (range 3.1-16), mean allopurinol dose was 192 mg/day (range 50-450) and mean estimated GFR was 23.8 mL ·

Significant univariate correlates of the administered doses of allopurinol were weight (r 0.317, P = 0.001), body mass index (BMI; r 0.313, P = 0.001), and female sex (r -0.198; P = 0.035).

Achieved sUA levels correlated directly with BMI (r 0.201, r = 0.036) but inversely with the allopurinol dose (r -0.196; P = 0.036).

Achieving the targe sUA level was positively correlated with BMI (β 0.271, P = 0.006) and inversely correlatd with allopurinol dose (β -0.258; P = 0.009).

In patients with advanced CKD, allopurinol dosing was insufficient, yet higher doses did not affect renal function.