title: Safety and efficacy of allopurinol in chronic kidney disease.
abstract: OBJECTIVE
  To review the evidence surrounding the use of allopurinol in chronic kidney disease (CKD) and discuss safety and efficacy considerations of such use.
  
  
  METHODS
  A literature search was conducted through MEDLINE (1950-July 2013), PubMed (1965-July 2013), and International Pharmaceutical Abstracts (1970-July 2013) using the search terms allopurinol and kidney or renal. In addition, reference citations from publications identified were reviewed.
  
  
  METHODS
  All articles in English identified from the data sources were evaluated for inclusion.
  
  
  RESULTS
  Gout management with allopurinol in patients with CKD can be challenging because of the risk of adverse events and uncertain efficacy. Not all gout treatment guidelines provide recommendations for allopurinol use specifically in patients with CKD. Literature regarding the safety and efficacy of dosing allopurinol in CKD has shown inconsistent results and is based primarily on retrospective, case cohort or observational data. Some trials have demonstrated an increased risk of allopurinol-induced adverse reactions in patients with CKD, whereas others have not confirmed renal insufficiency as a risk factor. More CKD patients achieved a target uric acid level in studies where the allopurinol dose was titrated to effect as compared with those studies in which patients were given renally adjusted or untitrated allopurinol doses.
  
  
  CONCLUSIONS
  Studies evaluating allopurinol use in patients with CKD have reported inconsistent findings relative to safety and efficacy. Providers should be aware of the potential risk of allopurinol hypersensitivity syndrome as well as the need for reducing the initiation dose and gradual titration of allopurinol to safely achieve a target serum urate level in this population.
authors.affiliation: Mercer University College of Pharmacy, Atlanta, GA, USA.
authors.forename: Maria Miller
authors.initials: MM
authors.lastname: Thurston
authors.forename: Beth Bryles
authors.initials: BB
authors.lastname: Phillips
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Bourg
mesh_terms: D000493:Allopurinol / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D006073:Gout / Q000188:drug therapy* / Q000209:etiology; D006074:Gout Suppressants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D006074:Gout Suppressants; D000493:Allopurinol
keywords: adverse effects; allopurinol; allopurinol hypersensitivity syndrome; chronic kidney disease; efficacy; renal; safety