Allopurinol not tied to higher mortality for patients with gout and chronic kidney disease

(HealthDay)—For patients with gout and chronic kidney disease (CKD), no associations with increased mortality were seen for allopurinol initiation, achieving target serum urate (SU) levels, or allopurinol dose escalation, according to a study published online Jan. 25 in the Annals of Internal Medicine.

Jie Wei, Ph.D., from Xiangya Hospital in Changsha, China, and colleagues examined the relations of allopurinol initiation, allopurinol dose escalation, and achieving target SU level (<0.36 mmol/L) after allopurinol initiation with all-cause mortality in a cohort of patients aged 40 years or older with gout and concurrent moderate-to-severe CKD.

The researchers found that among 5,277 allopurinol initiators and 5,277 propensity score-matched noninitiators, mortality was 4.9 and 5.8 per 100 person-years, respectively (hazard ratio, 0.85; 95 percent confidence interval, 0.77 to 0.93). The hazard ratio of mortality for achieving the target SU level versus not achieving the target SU level was 0.87 (95 percent confidence interval, 0.75 to 1.01) in the target trial emulation analysis. In the dose escalation group versus the no dose escalation group, the hazard ratio of mortality for allopurinol was 0.88 (95 percent confidence interval, 0.73 to 1.07).

"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 to achieve and maintain a SU target below a subsaturation point of urate crystals, which will eventually decrease gout flare frequency and tissue urate crystal burden," the authors write.

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