Allopurinol not associated with increased mortality in patients with CKD, gout

Allopurinol when given to achieve target serum urate levels did not increase mortality risk in patients with gout and chronic kidney disease (CKD), a study found.

In response to two recent randomized controlled trials suggesting that allopurinol was associated with a twofold increased risk for death in patients with renal disease but without gout, researchers studied electronic health records for 5,277 adults in the United Kingdom with gout and moderate to severe CKD. They examined allopurinol initiation, allopurinol dose escalation, and achievement of target serum urate level after allopurinol initiation for any association with all-cause mortality, tracking mortality over five years for each dosing stage and regimen. Results were published Jan. 25 by Annals of Internal Medicine.

The study found mortality rates of 4.9 and 5.8 per 100 person-years in 5,277 patients who initiated allopurinol and 5,277 propensity-score-matched patients who did not, respectively (hazard ratio [HR], 0.85; 95% CI, 0.77 to 0.93). Mortality among patients who achieved their target serum urate level was not significantly different from those that did not achieve the target (HR, 0.87; 95% CI, 0.75 to 1.01). The same was true when patients were analyzed by whether their dose was escalated (HR, 0.88; 95% CI, 0.73 to 1.07).

Despite the findings from the two earlier studies, starting allopurinol, achieving target serum urate level with allopurinol, and allopurinol dose escalation were not associated with an increased risk for death in patients with gout and concurrent CKD, the study authors concluded. They said that these findings may alleviate concern about using allopurinol. “Our findings are clinically relevant in gout care because CKD is a common comorbidity of gout, and allopurinol is most commonly used with escalating doses,” the authors wrote.