| アブストラクト | BACKGROUND: Two recent randomized clinical trials of escalating doses of allopurinol for the progression of chronic kidney disease (CKD) reported no benefits but potentially increased risk for death. Whether the risk could occur in patients with gout and concurrent CKD remains unknown. OBJECTIVE: To examine the relation of allopurinol initiation, allopurinol dose escalation, and achieving target serum urate (SU) level after allopurinol initiation to all-cause mortality in patients with both gout and CKD. DESIGN: Cohort study. SETTING: The Health Improvement Network U.K. primary care database (2000 to 2019). PARTICIPANTS: Patients aged 40 years or older who had gout and concurrent moderate-to-severe CKD. MEASUREMENTS: The association between allopurinol initiation and all-cause mortality over 5-year follow-up in propensity score (PS)-matched cohorts was examined. Analysis of hypothetical trials were emulated: achieving target SU level (<0.36 mmol/L) versus not achieving target SU level and dose escalation versus no dose escalation for mortality over 5-year follow-up in allopurinol initiators. RESULTS: Mortality was 4.9 and 5.8 per 100 person-years in 5277 allopurinol initiators and 5277 PS-matched noninitiators, respectively (hazard ratio [HR], 0.85 [95% CI, 0.77 to 0.93]). In the target trial emulation analysis, the HR of mortality for the achieving target SU level group compared with the not achieving target SU level group was 0.87 (CI, 0.75 to 1.01); the HR of mortality for allopurinol in the dose escalation group versus the no dose escalation group was 0.88 (CI, 0.73 to 1.07). LIMITATION: Residual confounding cannot be ruled out. CONCLUSION: In this population-based data, neither allopurinol initiation, nor achieving target SU level with allopurinol, nor allopurinol dose escalation was associated with increased mortality in patients with gout and concurrent CKD. PRIMARY FUNDING SOURCE: Project Program of National Clinical Research Center for Geriatric Disorders. |
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| 投稿者 | Wei, Jie; Choi, Hyon K; Neogi, Tuhina; Dalbeth, Nicola; Terkeltaub, Robert; Stamp, Lisa K; Lyu, Houchen; McCormick, Natalie; Niu, Jingbo; Zeng, Chao; Lei, Guanghua; Zhang, Yuqing |
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| 組織名 | Health Management Center, Xiangya Hospital, Central South University, Changsha,;China (J.W.).;Division of Rheumatology, Allergy, and Immunology, Department of Medicine, and;the Mongan Institute, Massachusetts General Hospital, Harvard Medical School,;Boston, Massachusetts (H.K.C., Y.Z.).;Section of Rheumatology, Boston University School of Medicine, Boston,;Massachusetts (T.N.).;Department of Medicine, University of Auckland, Auckland, New Zealand (N.D.).;Rheumatology, Allergy-Immunology Section, San Diego VA Medical Center, San Diego,;California (R.T.).;Department of Medicine, University of Otago, Christchurch, New Zealand (L.K.S.).;Department of Orthopedics, General Hospital of Chinese PLA, Beijing, and;Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha,;China (H.L.).;Boston, Massachusetts, and Arthritis Research Canada, Richmond, British Columbia,;Canada (N.M.).;Selzman Institute for Kidney Health, Section of Nephrology, Department of;Medicine, Baylor College of Medicine, Houston, Texas (J.N.).;Department of Orthopaedics, Xiangya Hospital, Central South University, and Hunan;Key Laboratory of Joint Degeneration and Injury, and National Clinical Research;Center of Geriatric Disorders, Xiangya Hospital, Central South University,;Changsha, China (C.Z.).;Department of Orthopaedics, Xiangya Hospital, Central South University, and;National Clinical Research Center of Geriatric Disorders, Xiangya Hospital,;Central South University, and Hunan Key Laboratory of Joint Degeneration and;Injury, Changsha, China (G.L.). |
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