Monday, 11 Nov 2019

You are here

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.

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.

Disclosures: 
The author has received compensation as an advisor or consultant on this subject

Add new comment

More Like This

T2T Lowers Mortality in Gout

A Spanish prospective cohort of active, uncontrolled gout patients were followed and showed that failure to reach a target serum uric acid (sUA) level of 6 mg/dl (0.36 mmol/L) or less was associated with a 2-3 fold increase in mortality.

Novel Inhibition of MSU Crystal Inflammation

Researchers from Washington State University have shown that inhibition of tumor growth factor-β (TGF-β)-activated kinase 1 (TAK1) can effectively downregulate inflammatory mediators and suppress inflammation caused by gout.

Monosodium urate (MSU) crystals directly activate the inflammasome to produce a plethora of pro-inflammatory cytokines, including interleukin-1β (IL-1β). 

Patients Prefer Nurse Led Care for their Gout

Despite the well known, well publicized treat-to-target (T2T) goal of a serum uric acid (SUA) level < 6 mg/dl, this goal is seldom achieved (< 40%) in clinical practice and patient adherence has been unacceptably low. A recent study shows that nurse-led care led to better outcomes in gout including patient acceptability, long-term adherence, and less flares.

Anakinra Use in Hospitalized Gout Patients

While the efficacy and safety of interleukin 1 (IL-1) inhibitors (e.g., anakinra) in the acute management of gout and pseudogout has been repeatedly shown, the cost efficacy of such biologic therapy has rendered it impractical for most. A new retrospective study has shown that IL-1 inhibitors may be effective and appropriate for some medically complex, hospitalized patients with acute gout or calcium pyrophosphate crystal arthritis.

Higher Rates of Venous Thromboembolism in Gout

A Canadian administrative claims analysis has shown that gout-associated inflammation increases the risk of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) before and after the diagnosis of gout.