Long-Term Allopurinol Improves CKD and Cardiovascular Outcomes

In patients with asymptomatic hyperuricemia, long-term treatment with allopurinol may slow the progression of chronic kidney disease (CKD) while reducing the risk of cardiovascular disease, reports the American Journal of Kidney Diseases.

In the original randomized trial, 113 patients with stable CKD were assigned to 2 years of allopurinol, 100 mg/day, or usual care. That study found a 47 percent reduction in progression of CKD in the allopurinol group, along with a decreased risk of cardiovascular events, reduced inflammatory markers, and fewer hospitalizations.

One hundred seven patients were followed up for as long as 5 additional years while they continued their assigned treatment. The rates of renal events (starting dialysis, doubling of serum creatinine, a 50 percent or greater reduction in estimated GFR, or a combination of these) and cardiovascular events were compared between groups.

During long-term follow-up, 12 of 56 patients in the treatment group stopped taking allopurinol, and 10 of 51 control individuals started allopurinol. At a total follow-up time of 84 months, renal events occurred in nine patients in the allopurinol group versus 24 in the control group.

The hazard ratio for renal events with allopurinol was 0.32, after adjustment for age, sex, baseline kidney function, uric acid level, and use of renin-angiotensin-aldosterone system blockers. The allopurinol group was also at lower risk of cardiovascular events: 16 versus 23 patients, adjusted hazard ratio 0.43.

The post hoc analysis suggests long-term benefits of allopurinol for patients with CKD. The results show reduced CKD progression along with lower cardiovascular risks for patients continuing allopurinol. The findings support large-scale controlled trials of uric acid–lowering therapy to prevent CKD progression [Goicoechea M, et al. Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial. Am J Kidney Dis 2015; 65:543–549].