Safety and Efficacy of Allopurinol in Chronic Kidney Disease

Thurston, Maria Miller; Phillips, Beth Bryles; Bourg, Catherine A.

doi:10.1177/1060028013504740

Cited by 31 publications

(26 citation statements)

References 31 publications

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“…23 Later studies have contradicted this notion. 24 However, it is recommended to begin with a low dose as recent work has shown that higher starting doses of allopurinol may increase the risk of allopurinol hypersensitivity syndrome. 25 The response to therapy has generally been monitored by assessment of 2,8-DHA crystals in the urine sediment, which may not be accurate enough to guide drug treatment.…”

Section: Discussionmentioning

confidence: 99%

Kidney Disease in Adenine Phosphoribosyltransferase Deficiency

Runólfsdóttir

Pálsson

Agustsdottir

et al. 2016

American Journal of Kidney Diseases

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Background Adenine phosphoribosyltransferase (APRT) deficiency is a purine metabolism disorder causing kidney stones and chronic kidney disease (CKD). The course of nephrolithiasis and CKD has not been well characterized. The objective of this study was to examine long-term kidney outcomes in patients with APRT deficiency. Study Design An observational cohort study. Setting & Participants All patients enrolled in the APRT Deficiency Registry of the Rare Kidney Stone Consortium. Outcomes Kidney stones, acute kidney injury (AKI), stage of CKD and kidney failure, estimated glomerular filtration rate (eGFR) and changes in eGFR. Measurements Serum creatinine and eGFR calculated using creatinine-based equations. Results Of 53 patients, 30 (57%) were female and median age at diagnosis was 37.0 (range, 0.6–67.9) years. The median duration of follow-up was 10.3 (range, 0.0–31.5) years. At diagnosis, kidney stones had developed in 29 patients (55%) and 20 (38%) had CKD stages 3–5, including 11 patients (21%) with stage 5. At latest follow-up, 33 patients (62%) had had kidney stones; 18 (34%), AKI; and 22 (42%), CKD stage 3–5. Of the 14 (26%) patients with CKD stage 5, 12 had initiated renal replacement therapy. Kidney stones recurred in 18 of 33 patients (55%). The median eGFR slope was −0.38 (range, −21.99 to 1.42) mL/min/1.73 m2 per year in patients receiving treatment with xanthine dehydrogenase inhibitor and −5.74 (range, −75.8 to −0.10) mL/min/1.73 m2 per year in those not treated prior to the development of stage 5 CKD (p=0.001). Limitations Use of observational registry data. Conclusions Progressive CKD and AKI episodes are major features of APRT deficiency, while nephrolithiasis is the most common presentation. Advanced CKD without history of kidney stones is more prevalent than previously reported. Our data suggest that timely therapy may retard CKD progression.

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Section: Discussionmentioning

confidence: 99%

Kidney Disease in Adenine Phosphoribosyltransferase Deficiency

Runólfsdóttir

Pálsson

Agustsdottir

et al. 2016

American Journal of Kidney Diseases

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“…It is likely that the harmful side effect/adverse reaction profile of these medications contributes to better awareness and knowledge. A recent review of the safety and efficacy of allopurinol in CKD suggests that incidence of allopurinol hypersensitivity syndrome and other adverse effects like Stevens-Johnson syndrome can occur with a higher frequency in patients with impaired renal function [53]. Similarly, colchicine toxicity is more common among those with renal impairment and can be fatal [54–56].…”

Section: Discussionmentioning

confidence: 99%

Awareness and knowledge among internal medicine house-staff for dose adjustment of commonly used medications in patients with CKD

et al. 2017

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BackgroundDrug dosing errors result in adverse patient outcomes and are more common in patients with chronic kidney disease (CKD). As internists treat the majority of patients with CKD, we study if Internal Medicine house-staff have awareness and knowledge about the correct dosage of commonly used medications for those with CKD.MethodsA cross-sectional survey was performed and included 341 participants. The outcomes were the awareness of whether a medication needs dose adjustment in patients with CKD and whether there was knowledge for the level of glomerular filtration rate (GFR) a medication needs to be adjusted.ResultsThe overall pattern for all post-graduate year (PGY) groups in all medication classes was a lack of awareness and knowledge. For awareness, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, endocrine, gastrointestinal, and rheumatologic medication classes but not for analgesic, cardiovascular, and neuropsychotropic medication classes. For knowledge, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, cardiovascular, endocrine, and gastrointestinal, medication classes but not for analgesic, neuropsychotropic, and rheumatologic medication classes.ConclusionsInternal Medicine house-staff across all levels of training demonstrated poor awareness and knowledge for many medication classes in CKD patients. Internal Medicine house-staff should receive more nephrology exposure and formal didactic educational training during residency to better manage complex treatment regimens and prevent medication dosing errors.

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“…A recent review study reported by Thurston et al [35] discussed efficacy and safety of allopurinol in patients with CKD. The authors reported that, 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.…”

Section: Dose Adjustment and Safety Of Allopurinol In Patients With Ckdmentioning

confidence: 99%

“…The authors reported that, 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 [35]. …”

Section: Dose Adjustment and Safety Of Allopurinol In Patients With Ckdmentioning

confidence: 99%

Allopurinol as a Kidney-Protective, Cardioprotective, and Antihypertensive Agent: Hype or Reality?

Kanbay

Solak

Gaipov³

et al. 2014

Blood Purif

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Numerous experimental and clinical studies suggest that uric acid might have pathobiologic implications in the development and progression of hypertension, kidney disease, and coronary heart disease, among others, resulting in renewed interest in uric acid as a potential pathogenic mediator in these clinical conditions. Despite encouraging animal studies showing beneficial roles of allopurinol, clinical studies and randomized controlled trials remain scarce, and, despite available clinical evidence supporting a therapeutic role for allopurinol, multiple issues remain before routine use of allopurinol can be recommended for use in patients with hyperuricemia and hypertension, kidney disease, or coronary heart disease. These include a need for more robust clinical trial data that evaluate efficacy on hard clinical outcomes, optimal dose, duration of treatment, and the potential for serious allergic reactions. In this article we review the current available evidence describing the effects of allopurinol in hypertension, kidney disease, and coronary heart disease, highlighting unresolved issues surrounding allopurinol use for uric acid lowering in individuals without gout.

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Safety and Efficacy of Allopurinol in Chronic Kidney Disease

Cited by 31 publications

References 31 publications

Kidney Disease in Adenine Phosphoribosyltransferase Deficiency

Kidney Disease in Adenine Phosphoribosyltransferase Deficiency

Awareness and knowledge among internal medicine house-staff for dose adjustment of commonly used medications in patients with CKD

Allopurinol as a Kidney-Protective, Cardioprotective, and Antihypertensive Agent: Hype or Reality?

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