Effect of Allopurinol on Progression of Chronic Kidney Disease

Allopurinol didn't provide renal protection, according to the results of two randomized trials. Researchers have long debated whether hyperuricemia causes decline in renal function. In two randomized trials, investigators inform this controversy by examining whether urate-lowering therapy affects the course of chronic kidney disease (CKD).

One trial involved 267 patients (mean age, 51) with longstanding type 1 diabetes, serum urate levels ≥4.5 mg/dL, estimated glomerular filtration rate (eGFR) between 40 and 100 mL/minute/1.73 m2, and either proteinuria or documented decline in eGFR (of ≥3 mL/minute annually during the previous several years).

Patients received either allopurinol (titrated to 200 to 400 mg daily) or placebo; allopurinol reduced mean uric acid levels from 6.1 mg/dL to 3.9 mg/dL. During 3 years of follow-up, renal function declined to the same extent in both groups, and allopurinol had no effect on proteinuria.

Another trial involved 369 patients (mean age, 62) with stage 3 or 4 CKD and either proteinuria or reduction in eGFR of ≥3 mL/minute during the previous year; about half the patients had diabetic nephropathy.

Patients received allopurinol (300 mg daily in most cases) or placebo for 2 years; allopurinol reduced mean uric acid levels from 8.2 mg/dL to 5.3mg/dL. As in the first study, allopurinol did not affect rate of decline in renal function or degree of proteinuria.

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Source-Medindia