Use of Allopurinol in Slowing the Progression of Renal Disease Through Its Ability to Lower Serum Uric Acid Level

21 Sep, 10

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Use of Allopurinol in Slowing the Progression of Renal Disease

Aim

To investigate the renal effects of allopurinol treatment in hyperuricemic patients with chronic kidney disease (CKD)

Methods

Inclusion

1. Presence of renal disease, defined as daily proteinuria >0.5 g and/or an elevated serum creatinine (Cr) level >1.35 mg/dL (>120 mol/L) at baseline;

2. Baseline serum Cr level and daily proteinuria had not increased by >40% within the 3 months before screening

Treatment Protocol

Treatment group n=25

Depending on baseline renal function, allopurinol -

200 mg/d was started, if serum Cr <1.70 mg/dL
100 mg/d was started, if serum Cr >1.70 mg/dL

Dosages of antihypertensive drugs, lipid-lowering agents, and steroid or cytotoxic drugs were continued and adjusted according to the individual patient's clinical conditions.

Follow-up

Patients were checked for BP, Fasting uric acid, Serum Cr, Daily urinary protein excretion, Hematological parameters, every 4 weeks for the first 6 months and then every 8 weeks, for a total of 12 months.

Results

Biochemical Parameter

Renal Function

No significant change in serum Cr levels after 12 months in the treatment group. In the control group, there was worsening of renal function by the end of the study

Proteinuria

Baseline protein excretion was similar in both groups at the end of the study.

Haematologic Parameters

No changes in serum ALT, Lipid profile, CRP, Hb or WBC and platelet counts after 12 months.

Study Endpoint Outcome

* - serum Cr level at the end of study that increased by <40% compared with baseline

# - serum Cr level increased by >40% compared with baseline, but not yet requiring dialysis
$ - requiring dialysis therapy

Significantly (P =0.015) more patients in the control group showed deterioration in kidney function at the end of the study.

Conclusion

Allopurinol Therapy

Significantly decreases S. uric acid levels in hyperuricemic patients with mild to moderate CKD
Is safe and helps preserve kidney function during 12 months of therapy compared with controls
May be necessary earlier to ameliorate the hypertensive effect of hyperuricemia

Using allopurinol to decrease serum uric acid levels is safe and may be beneficial in decreasing systolic BP and slowing the rate of deterioration in renal function

Reference

Am J Kidney Dis. 2006;47(1):51-9