A study presented at the 2016 American College of Rheumatology/ARHP Annual Meeting showed that consumption of the commonly used drug allopurinol, trade name Zyloprim, used to lower the levels of urate in the blood, does not increase the risk of kidney deterioration in patients with gout.
Gout is a characterized by a defective metabolism of uric acid, with high levels of uric acid and urate in the blood. Patients with this disease frequently develop arthritis due to accumulation of uric acid derived crystals frequently in the joints. In some patients, gout condition can contribute to chronic kidney disease (CKD).
Although high blood levels of uric acid or urate (hyperuricemia) can contribute to CKD, allopurinol to treat these patients it is not commonly used in clinics due to its potential adverse events.
The study “No Increased Risk of Chronic Kidney Disease with Allopurinol Use,” supported by the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases, intended to better understand the underlying risk of allopurinol use in gout patients who have normal kidney function.
“Gout management is frequently suboptimal. Further exacerbating this poor management is the common practice of lowering the dose of or stopping allopurinol when a patient with gout begins to have a decline in kidney function, which inevitably adds to the poor control of their gout,” Ana Beatriz Vargas-Santos, MD, the researcher who conducted the study, said in a press release.
The study included 13,727 gout patients who initiated Zyloprim and 13,727 gout patients who were Zyloprim non-users, aged 18 to 89, with a mean follow-up time of four years for both groups. All the patients’ health information was collected from The Health Improvement Network (THIN) database from the United Kingdom.
Researchers looked at the relationship between Zyloprim use and the development of moderate (Stage 3) or severe CKD (Stages 4 and 5).
They reported that 1,401 of the Zyloprim-treated patients and 1,319 non-users developed moderate or severe CKD, resulting in a relative non-statistically significant risk of 1.05. This result was indicative of no association with Zyloprim use with an increased risk of developing moderate or severe CKD, compared with non-users.
In summary, this study showed that Zyloprim treatment could be used to help gout patients reduce blood levels of uric acid and urate without increasing risk to damaging the kidneys.
“Our results help to mitigate the concern that allopurinol is harmful to the kidney functioning of patients with gout,” said Vargas-Santos. “This might encourage physicians to properly dose allopurinol, resulting in better outcomes for these patients. More studies are needed to further clarify this issue, including studies among subjects with established and advanced chronic kidney disease.”