Low-Dose Allopurinol Promotes Greater Serum Urate Lowering in Gout Patients with Chronic Kidney Disease Compared with Normal Kidney Function.


Journal Article

OBJECTIVES: Gout patients with chronic kidney disease (CKD) accumulate the active allopurinol metabolite oxypurinol, suggesting that allopurinol may promote greater serum urate (sU) lowering in CKD patients. METHODS: We identified all patientswith gout diagnoses on either 100 mg or 300 mg of allopurinol daily, with available pre- and on-treatment sU levels, in our system in a 1-year period. Mean sU decrement by dosing per CKD groups was determined by CKD stage. RESULTS: Of 1,288 subjects with gout, 180 met entry criteria, with 83 subjects receiving 100 mg and 97 receiving 300 mg allopurinol. Subjects with CKD stage 1 experienced less sU lowering with 100 mg than 300 mg of allopurinol. Subjects with stage 4 and 5 CKD had equivalent sU decreases across the 100 mg and 300 mg allopurinol groups. However, the 100 mg group started at a higher pre-treatment sU and ended at a higher final sU than the 300 mg group. CONCLUSIONS: The strategy of titrating allopurinol to sU in patients with kidney impairment may result in greater sU lowering at lower doses than in patients without CKD but may also pose a treatment challenge from a possible drug ceiling effect.

Full Text

Cited Authors

  • Toprover, M; Crittenden, DB; Modjinou, DV; Oh, C; Krasnokutsky, S; Fisher, MC; Keenan, RT; Pillinger, MH

Published Date

  • March 2019

Published In

Volume / Issue

  • 77 / 2

Start / End Page

  • 87 - 91

PubMed ID

  • 31140959

Pubmed Central ID

  • 31140959

Electronic International Standard Serial Number (EISSN)

  • 2328-5273


  • eng

Conference Location

  • United States