Allopurinol Shown to be Renal Protective Save

Neogi and colleagues have shown that standard doses of allopurinol (300 mg/day) were associated with a 13% lower risk of renal function deterioration in chronic gout patients - thus, allopurinol does not appear to impair renal function over time.

Historically, it has been claimed that allopurinol should be dose-adjusted in patients with renal insufficiency, implying that the drug may lend to renal impairment in susceptible individuals.

Researchers used a UK population for a prospective cohort study of newly diagnosed gout patients initiating allopurinol (≥300 mg/d) compared to those who did not initiate allopurinol. Thus, adults with newly diagnosed gout were propensity matched: 4760 initiators of allopurinol (≥300 mg/d) vs. the same number of noninitiators of allopurinol. Patients with chronic kidney disease stage 3 or higher or prior urate-lowering therapy were excluded.

Patients had a mean follow-up time of 4-5 years, mean age of 57 years, and mean body mass index 30.

Amongst these patients, chronic kidney disease stage 3 or higher was seen in 11.1% of allopurinol initiators and 13.1% of non-users.

Allopurinol (≥300 mg/d) was associated with a 13% lower risk of developing developing chronic kidney disease stage 3 or higher compared with nonusers (hazard ratio (HR) 0.87; 95% CI, 0.77-0.97).  Doses lower than 300 mg/d were not associated with protection against stage >3 CKD (HR, 1.00; 95% CI, 0.91-1.09).

Allopurinol dosed at 300 mg/d or higher was associated with a lower risk of renal function deterioration.