title: Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial.
abstract: BACKGROUND
  Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved estimated glomerular filtration rate and reduced CV risk.
  
  
  METHODS
  Post hoc analysis of a long-term follow-up after completion of the 2-year trial.
  
  
  METHODS
  113 participants (57 in the allopurinol group and 56 in the control group) initially followed up for 2 years and 107 participants followed up to 5 additional years.
  
  
  METHODS
  Continuation of allopurinol treatment, 100mg/d, or standard treatment.
  
  
  RESULTS
  Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or ≥50% decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction, coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).
  
  
  RESULTS
  During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with 6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up, an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus, during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P=0.004; adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the control group (HR, 0.43; 95% CI, 0.21-0.88; P=0.02; adjusted for age, sex, and baseline kidney function).
  
  
  CONCLUSIONS
  Small sample size, single center, not double blind, post hoc follow-up and analysis.
  
  
  CONCLUSIONS
  Long-term treatment with allopurinol may slow the rate of progression of kidney disease and reduce CV risk.
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: marian.goicoechea@gmail.com.
authors.forename: Marian
authors.initials: M
authors.lastname: Goicoechea
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Soledad
authors.initials: S
authors.lastname: Garcia de Vinuesa
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ursula
authors.initials: U
authors.lastname: Verdalles
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Verde
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Macias
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Santos
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Pérez de Jose
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Cedeño
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Tania
authors.initials: T
authors.lastname: Linares
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Luño
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000494:pharmacology / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006074:Gout Suppressants / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol; D003404:Creatinine
keywords: Chronic kidney disease (CKD) progression; allopurinol treatment; cardiovascular (CV) risk; hyperuricemia; renal disease; uric acid concentration