Higher Allopurinol Dose May be Nephroprotective in Elderly
A higher allopurinol dose provided a protective effect against incident renal failure in elderly patients, according to a study published in Annals of the Rheumatic Diseases.
Dr. Jasvinder A. Singh, from Birmingham VA Medical Center, Alabama, and coauthors set out to assess the effect of allopurinol dose and duration on the risk of renal failure in elderly patients who use the treatment. They used the 5% random medicare claims data from 2006–2012 and performed multivariable-adjusted Cox regression analyses to evaluate the association of allopurinol with subsequent risk of developing incident renal failure or end-stage renal disease (ESRD); the analyses were controlled for age, sex, race, and Charlson-Romano comorbidity index.
The study authors found 8,314 incident renal failure episodes among the total 30,022 allopurinol treatment episodes. Doses of 200mg–299mg/day (HR 0.81, 95% CI: 0.75–0.87) and ≥300mg/day (HR 0.71, 95% CI: 0.67-0.76) had significantly lower hazard of renal failure when compared with doses of 1mg–199mg/day.
Also, longer treatment duration with allopurinol was significantly associated with lower hazards in sensitivity analyses: 0.5–1 year (HR 1.00, 95% CI: 0.88–1.15); >1–2 years (HR 0.85, 95% CI: 0.73–0.99); and >2 years (HR 0.81, 95% CI: 0.67–0.98). Allopurinol doses ≥300mg/day were also linked to a significantly lower risk of acute renal failure (HR 0.89, 95% CI: 0.83–0.94) and ESRD (HR 0.57, 95% CI: 0.46–0.71).
Dr. Singh concluded that a higher allopurinol dose was "independently protective against incident renal failure in the elderly allopurinol users," and longer allopurinol use may be associated with lower risk of incident renal failure. Dr. Singh added that possible mechanisms behind these effects need to be studied.
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