title: Allopurinol and kidney function: An update.
abstract: Allopurinol is the most commonly used urate lowering therapy in the management of gout. Despite the fact that it has been available for over 40 years there is ongoing debate about optimal allopurinol dosing in gout patients with chronic kidney disease. Given that gout is common in patients with renal impairment, clinicians need to be aware of the relationships between serum urate and kidney function as well as the effects of allopurinol on kidney function and vice versa. The use of allopurinol in patients on dialysis is an understudied area. Dialysis reduces plasma oxypurinol concentrations, therefore the dose and time of administration in relationship to dialysis need to be carefully considered. Recently, it has been suggested that there may be a role for allopurinol in patients with chronic kidney disease without gout. Observational studies have reported an association between serum urate and chronic kidney disease and end stage renal failure. The effect of urate lowering therapy with allopurinol on progression of kidney disease has been examined in small studies with varying results. Larger clinical trials are currently underway. This review will examine the relationships between allopurinol and kidney function in adults with and without renal disease and address allopurinol dosing in gout patients with impaired kidney function.
authors.affiliation: Department of Medicine, University of Otago, P.O. Box 4345, Christchurch 8140, New Zealand; Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. Electronic address: lisa.stamp@cdhb.health.nz.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Stamp
authors.affiliation: Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Chapman
authors.affiliation: Department of Medicine, University of Otago, P.O. Box 4345, Christchurch 8140, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
mesh_terms: D000493:Allopurinol / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003404:Creatinine / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006073:Gout / Q000150:complications / Q000188:drug therapy*; D006074:Gout Suppressants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy
chemical_list: D006074:Gout Suppressants; D000493:Allopurinol; D003404:Creatinine
keywords: Allopurinol; Chronic kidney disease; Gout; Kidney function; Oxypurinol