A drug commonly used to treat gout may help maintain kidney disease patients' health, according to an analysis appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The research is the first to show that allopurinol treatment in patients with chronic kidney disease (CKD) decreases inflammation, slows the progression of kidney disease, and reduces patients' risk of experiencing a cardiovascular event or being hospitalized.
Allopurinol is a drug used primarily to treat individuals with excess uric acid in their blood (hyperuricemia). (The agent inhibits an enzyme involved in the production of uric acid.) Hyperuricemia can lead to gout and, in extreme cases, kidney failure. Elevated uric acid levels in the blood may also increase one's risk of developing hypertension and heart disease. Patients with CKD–who most often die from heart disease—often experience hyperuricemia because of decreased uric acid excretion in the urine; however, studies have not looked at the benefits of allopurinol in these individuals.
To investigate, Marian Goicoechea, PhD, Jose Luño, MD (Hospital General Universitario Gregorio Marañón, in Madrid, Spain) and their colleagues conducted a prospective, randomized trial of 113 CKD patients who received either allopurinol (100 mg/day) or who continued taking their usual therapy. The researchers assessed kidney disease progression, cardiovascular events (such as heart attacks), and hospitalizations among patients in the study over two years.
The blood levels of uric acid and C-reactive protein (a marker of inflammation) significantly decreased in patients treated with allopurinol. In the control group, kidney function declined after two years, but in the allopurinol-treated group, kidney function improved. Allopurinol treatment slowed down kidney disease progression regardless of patients' age, gender, and diabetes status; their blood levels of uric acid and C-reactive protein; the amount of protein patients lost in the urine; and the other types of medications patients used. In addition, compared with usual therapy, allopurinol treatment reduced the risk of cardiovascular events by 71% and the risk of hospitalizations by 62%.
While allopurinol has significant potential benefits for CKD patients, "these results have to be confirmed in larger prospective trials and are the basis for a hypothesis that still needs to be tested," the authors wrote.
Study co-authors include Soledad García de Vinuesa, Ursula Verdalles, Caridad Ruiz-Caro, Jara Ampuero, Abraham Rincón, and David Arroyo of Hospital General Universitario Gregorio Marañón.
Disclosures: The authors reported no financial disclosures.
The article, entitled "Effect of Allopurinol in Chronic Kidney Disease Progression and Cardiovascular Risk," will appear online at http://cjasn.asnjournals.org/ on June 10, 2010, doi 10.2215/CJN.01580210.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.
Clinical Journal of the American Society of Nephrology