Allopurinol is a commonly prescribed drug for people with chronic kidney disease (CKD) that helps reduce uric acid levels in the blood. These levels are typically high in people with CKD because the kidneys fail to remove uric acid from the blood. 

High urate levels may be linked to a greater risk of developing chronic kidney disease and to a higher risk of disease progression. A clinical trial in Australia, however, recently found that allopurinol is ineffective in preventing the disease from worsening.*

What they did

The trial followed 363 people over two years with stage 3 or stage 4 CKD who were at increased risk of the disease worsening. One group of participants was given the drug allopurinol, while the other group was given a placebo.

What they found

The researchers found that the participants prescribed allopurinol experienced a 35% reduction in their blood urate levels, but this had no impact on the rate of kidney function decline. Moreover, kidney function declined at similar rates between participants prescribed allopurinol and those who were given a placebo.

Based on the study’s results, the researchers stated that they found there is no benefit in prescribing this medication unless there is an additional specific medical reason, such as gout (a form of arthritis that may present in kidney disease patients).

What it means

Researchers note that, although the study had some limitations, doctors should still reconsider prescribing allopurinol to kidney disease patients and find another way to slow down the progression of the disease, as uric acid reduction may not need to be the focal point.

The study results should shift providers away from the idea that lowering uric acid will, in turn, slow progression of kidney disease. They found that elevated urate levels in the blood are likely to indicate the presence of kidney dysfunction rather than that they cause reduced kidney function.

“The thought was that allopurinol, by inhibiting urate levels, slows down progression of kidney disease, as uric acid can be toxic to the kidneys,” said said Dr. Anjay Rastogi, director of the CORE Kidney Program at the University of California, Los Angeles. “These trials indicate that might not be the case. Similar results were seen with another uric acid lowering drug, febuxostat.”

More research is needed to understand the impact of uric acid on kidney health and what alternatives can prevent the progression of kidney disease.

*Pratt, E. (2020, June 30). Commonly Prescribed Drug Found to Be Ineffective in Slowing Kidney Disease. Healthline. https://www.healthline.com/health-news/drug-allopurinol-ineffective-in-slowing-kidney-disease