The Effect of Allopurinol on Renal Function.

Area of Science:

• Nephrology
• Pharmacology
• Internal Medicine

Background:

• Hyperuricemia is linked to gout, hypertension, and kidney disease.
• The effect of allopurinol on renal function, particularly in chronic kidney disease patients, remains unclear.
• Patients with chronic kidney disease face a higher risk of allopurinol hypersensitivity reactions.

Purpose of the Study:

• To assess the impact of allopurinol on kidney function in male veterans with hyperuricemia.
• To investigate the relationship between allopurinol treatment and changes in estimated glomerular filtration rate (eGFR) and creatinine levels.

Main Methods:

• Retrospective cohort study of 100 male veterans (50 treated with allopurinol, 50 controls) from the Veterans Administration New York Harbor Healthcare System.
• Patients had hyperuricemia (serum uric acid > 7 mg/dL) and were newly started on allopurinol.
• Matching criteria included age, race, sex, and initial eGFR; follow-up averaged 3.4 years.

Main Results:

• Allopurinol-treated patients showed a significantly higher eGFR (11.9 mL/min increase) compared to controls (P = 0.01).
• The treatment effect on eGFR was dependent on the initial eGFR, with greater benefits observed at higher initial eGFR levels.
• A significant decrease in final creatinine levels was observed in the allopurinol group (0.10 mg/dL lower; P = 0.04).
• Five mild adverse events were reported in the allopurinol-treated group.

Conclusions:

• Allopurinol treatment over 3.4 years significantly improved kidney function in this cohort of hyperuricemic male veterans.
• The findings suggest allopurinol may offer a renal benefit in patients with hyperuricemia and maintained renal function.
• Clinicians should consider allopurinol's potential positive impact on kidney function when treating hyperuricemic patients.