Kidney Week

Abstract: FR-PO167

Determining the Association of Allopurinol Prescription on Progression of Renal Dysfunction and Progression to Renal Replacement Therapy in Patients with CKD

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Mallett, Andrew John, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Andrew John Mallett,

• Jeyaruban, Andrew Sujeevan, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Andrew Sujeevan Jeyaruban,

• Cameron (Salisbury), Anne, The University of Queensland, Brisbane, Queensland, Australia

Anne Cameron (Salisbury),

• Zhang, Jianzhen, The University of Queensland, Brisbane, Queensland, Australia

Jianzhen Zhang,

• Healy, Helen G., Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

Helen G. Healy,

• Hoy, Wendy E., The University of Queensland, Brisbane, Queensland, Australia

Wendy E. Hoy,

Group or Team Name

• on behalf of the CKD.QLD consortium

Background

Reports in the literature link hyperuricaemia with incident chronic kidney disease CKD. However, the relationship between allopurinol prescription and progression of renal dysfunction is not well understood. We aimed to determine the association of allopurinol prescription and changes in kidney function amongst patients with CKD.

Methods

A retrospective cohort study of 1,123 patients of a tertiary teaching hospital registered in the CKD.QLD registry between January 2011 and August 2017 (minimum of 2 years follow-up). Subject demographics (age), health data (BMI, comorbidities, laboratory test results) and allopurinol prescription were extracted from integrated medical records. Delta eGFR (CKD-EPI)was calculated as the difference between latest eGFR and initial eGFR. Subjects were stratified into two groups based on prescription of allopurinol.

Results

Subjects prescribed allopurinol were older (70.7 vs 65.8; p<0.01), had higher BMI (32.3kg/m² vs 30.5kg/m²; p<0.01), worse renal function (35.2mL/min/1.73m² vs 43.6mL/min/1.73m²; p<0.01), higher urate level (0.47mmol/L vs 0.42mmol/L; p<0.01) as well as higher proportion of diabetes (54% vs 46%; p=0.04), dyslipidaemia (54% vs 41%; p<0.01), hypertension (84% vs 72%, p<0.01) and gout (54% vs 11%; p<0.01). The proportion of subjects treated with allopurinol increased with CKD stage; stage 1:1.5%, stage 2:7.1%, stage 3: 21.7%, stage 4: 21.4% stage 5:17.3%.
Prescription of allopurinol did not have a significant association with delta eGFR in patients with hyperuricaemia (1.8mL/min/1.73m²/yearvs 1.6mL/min/1.73 m²/year; p=0.2) or gout (2.2mL/min/1.73m²/year vs 1.8mL/min/1.73m²/year; p=0.5). Nor was allopurinol prescription in the subgroup with serum urate level < 0.36mmol/L associated with a significant change in delta eGFR (3.5mL/min/1.73m²/year vs 1.6mL/min/1.73m²/year;p=0.17).Multivariate analysis adjusting for age and comorbidities found no significant association of allopurinol prescription with either delta eGFR or progression to kidney replacement therapy (p>0.05).

Conclusion

Allopurinol prescription was more prevalent in advanced CKD. However, it did not appear to be independently associated with deterioration of kidney function.