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Allopurinol reduces cardiovascular risks and improves renal function in pre-dialysis chronic kidney disease patients
Siren Sezer, Sebnem Karakan1, Berna Atesagaoglu
1Department of Nephrology, Baskent University, Ankara, Turkey.
Insights
Allopurinol therapy may slow kidney function decline in chronic kidney disease (CKD) patients by reducing uric acid (UA) and improving renal resistance index (RRI). This study suggests allopurinol is a promising treatment for pre-dialysis CKD progression.
Area of Science:
- Nephrology
- Internal Medicine
- Pharmacology
Background:
- Hyperuricemia is common in chronic kidney disease (CKD) and may contribute to renal function decline.
- Allopurinol is a xanthine oxidase inhibitor used to lower serum uric acid (UA) levels.
- The impact of allopurinol on renal function in pre-dialysis CKD patients requires further investigation.
Purpose of the Study:
- To evaluate the effect of allopurinol therapy on renal function in patients with CKD stages 3-4.
- To assess the relationship between serum uric acid levels, allopurinol use, and renal function parameters.
Main Methods:
- A cohort of 96 patients with CKD stages 3-4 were divided into allopurinol users (n=49) and non-users (n=47).
- Renal function (eGFR), serum uric acid (UA), C-reactive protein (CRP), potassium, LDL, and renal resistance index (RRI) were monitored over 12 months.
- Statistical analyses, including regression analysis, were performed to identify factors affecting renal function loss.
Main Results:
- Allopurinol therapy significantly decreased serum UA and CRP levels.
- The allopurinol group showed an increase in mean eGFR (3.3 mL/min/1.73 m²/year), while the control group showed a decrease (-1.3 mL/min/1.73 m²/year) (P=0.04).
- Allopurinol users had lower serum potassium, LDL, and RRI. UA and RRI were independent predictors of renal function loss.
Conclusions:
- Allopurinol therapy appears to be a beneficial option for managing renal progression in pre-dialysis CKD patients.
- Lowering serum UA levels with allopurinol may help preserve renal function.
- Reduced RRI and UA levels are associated with more stable renal function in CKD patients.
Abstract:
To determine the effect of hyperuricemia and allopurinol therapy on renal functions in chronic kidney disease (CKD) stage 3-4, we studied 96 patients in stage 3-4 CKD (57% male, age 65.3 ± 12.4 years). The mean estimated glomerular filtration rate (GFR) was 44.62 ± 14.38 iriL/ min/1.73 m 2 . The study patients were divided into non-allopurinol users (n = 47) and those using allopurinol (n = 49) in the last 12 months. Serum uric acid (UA) and C-reactive protein levels decreased after allopurinol therapy (P = 0.00 and P = 0.04, respectively), but no change was observed in the control group during the study period. In the allopurinol group, the mean GFR increased 3.3 ±1.2 mL/min/1.73 m 2 /year, while it decreased 1.3 ± 0.6 mL/min/1.73 m 2 in the control group during the follow-up period (P = 0.04); the patients in the allopurinol group exhibited lower levels of serum potassium, serum low-density lipoprotein (LDL) and renal resistance index (RRI) (P-values were <0.05). The patients with stable renal functions or GFR change <10% (n = 25) at the end of 12 months had significantly lower LDL and RRI values and more allopurinol users than the group with decreasing GFR (74% vs. 48%, P <0.05). In the regression analysis, UA and RRI were found as independent variables (r 2 = 0.68, P <0.01; r 2 = 0.25, P <0.01) that affected loss of renal function. We conclude that our study suggests a role for allopurinol, an effective agent in lowering serum UA levels, as a reliable therapeutic option in controlling renal progression in pre-dialysis CKD patients.
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