Renal Consult is edited by Jane S. Davis, CRNP, DNP, a member of the Clinician Reviews editorial board, who is a nurse practitioner in the Division of Nephrology at the University of Alabama at Birmingham and is the communications chairperson for the National Kidney Foundation’s Council of Advanced Practitioners (NKF-CAP); and Kim Zuber, PA-C, MSPS, DFAAPA, a semi-retired PA who works with the American Academy of Nephrology PAs and is a past chair of the NKF-CAP. This month’s responses were authored by Nicole D. McCormick, MS, MBA, NP-C, CCTC, who practices at the University of Colorado Renal Transplant Clinic in Aurora, Colorado, and Mary Rogers Sorey, MSN, who is an Assistant in Medicine in the Division of Nephrology and Hypertension at Vanderbilt University Medical Center, Nashville.
Q)I overheard a conversation at the hospital in which one of the nephrologists told an internist that allopurinol is better than other medications for treating gout because it slows the progression of chronic kidney disease (CKD). What does the data say?
CKD is a growing problem in America; the number of adults with CKD doubled from 2000 to 2008.1 Gout is considered an independent risk factor for CKD progression.2 Some randomized controlled trials (RCTs) have shown an association between allopurinol use and decreased proteinuria.3
A recent large retrospective review of Medicare charts assessed the correlation between use and dose of allopurinol and incidence of renal failure in patients older than 65.1 The researchersfound that, compared with lower doses, allopurinol doses of 200 to 299 mg/d and > 300 mg/d were associated with a significantly lower hazard ratio for kidney failure, in a multivariate-adjusted model. The findings therefore suggest that doses > 199 mg may slow progression to kidney failure in the elderly.
