Objectives: To evaluate the appropriate use of allopurinol in patients with history of chronic kidney disease (CKD) based on published literature, clinical studies, and analyses and to determine therapeutic success and efficacy of renally adjusted allopurinol for the treatment of gout.
Methods: Randomized control trials, literature reviews, meta-analyses, and ongoing trials were searched using PubMed, and Clinical Key, using the search terms “allopurinol,” “renal dosing adjustment,” “chronic kidney disease,” and “hypersensitivity syndrome” for relevant literature. The references for each identified article were evaluated for other applicable articles. Clinical trials assessing the effectiveness of renal dose adjustment of allopurinol in patients with CKD were included.
Results: Of the 27 sources that were found, 11 articles were relevant to the objective of this study and were included in this review. Currently, the American College of Rheumatology Guidelines recommends dose adjustments of allopurinol at initiation based on renal function to mitigate risk of allopurinol hypersensitivity syndrome (AHS). After initiation, all patients should be titrated to therapeutic doses regardless of renal function. However, CKD patients are not being titrated to therapeutic doses after the initial dose adjustment. Therefore, patients with CKD that received renally adjusted doses often fail to reach therapeutic level of drug. Current literature suggests that treatment failure of renally adjusted doses of allopurinol to control hyperuricemia may outweigh the risk of AHS development in patients with CKD.
Conclusions: Further studies are needed to clarify the safety and efficacy of allopurinol dose adjustment for patients with altered renal function for treatment success.