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Association of C hronic K idney D isease with Allopurinol Use in Gout Treatment

Association of C hronic K idney D isease with Allopurinol Use in Gout Treatment. Ana Beatriz Vargas-Santos, MD ; Christine E. Peloquin , MPH ; Yuqing Zhang, DSc ; Tuhina Neogi , MD, PhD JAMA Internal Medicine 2018;178(11):1526-1533. Research Question.

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Association of C hronic K idney D isease with Allopurinol Use in Gout Treatment

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  1. Association of Chronic Kidney Diseasewith Allopurinol Use in Gout Treatment Ana Beatriz Vargas-Santos, MD; Christine E. Peloquin, MPH; Yuqing Zhang, DSc; TuhinaNeogi, MD, PhD JAMA Internal Medicine2018;178(11):1526-1533.

  2. Research Question • What is the association of allopurinol use in patients with gout with the risk of developing chronic kidney disease stage 3 or higher?

  3. 痛風的成因

  4. Importance • Clinicians are often cautious about use of allopurinol in patients with gout when renal function declines • there is no evidence that allopurinol is nephrotoxic

  5. Objective   • To assess the association of allopurinol use in gout with the risk of developing chronic kidney disease stage 3 or higher.

  6. Study Design • time-stratified PSM cohort study • data sources: UK GPs (The Health Improvement Network)

  7. Study Design • Included • 18-89 years, new dx. gout • 2000/1/1−2014/12/31 • @ last 1 year • Excluded • prior CKD stage 3↑ (& ESRD) • prior urate-lowering therapy • prior other conditions • due to time-stratified PSM cohort study design

  8. Outcome definition

  9. Statistical analysis • Cox proportional hazards model • Kaplan-Meier curves • Sensitivity analysis • censoring at exposure status change • included all allopurinol initiators (dose <300 mg/d)

  10. Results

  11. Results

  12. Results

  13. Results

  14. Results

  15. Discussion • previous studies about allopurinol … • no significant association with renal function • but not directly applicable to gout patients • gout studies • small sample sizeor not target for gout (hypertensive) • same founding with other studies  potential beneficial

  16. Strengths & Limitations

  17. Conclusion • Allopurinolwas associated with 13%reduction the riskof developingCKD stage 3+

  18. Comments

  19. Thanks for your attentionAny comments?

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