Allopurinol reduces cardiovascular risks and improves renal function in pre-dialysis chronic kidney disease patients with hyperuricemia

To determine the effect of hyperuricemia and allopurinol therapy on renal functions in chronic kidney disease (CKD) stage 3–4, we studied 96 patients in stage 3–4 CKD (57 % male, age 65.3 ± 12.4 years). The mean estimated glomerular filtration rate (GFR) was 44.62 ± 14.38 mL / min / 1.73 m². The study patients were divided into non-allopurinol users (n = 47) and those using allopurinol (n = 49) in the last 12 months. Serum uric acid (UA) and C-reactive protein levels decreased after allopurinol therapy (P = 0.00 and P = 0.04, respectively), but no change was observed in the control group during the study period. In the allopurinol group, the mean GFR increased 3.3 ± 1.2 mL / min / 1.73 m2 / year, while it decreased 1.3 ± 0.6 mL / min / 1.73 m2 in the control group during the follow-up period (P = 0.04) ; the patients in the allopurinol group exhibited lower levels of serum potassium, serum low-density lipoprotein (LDL) and renal resistance index (RRI) (P-values were < 0.05). The patients with stable renal functions or GFR change < 10 % (n = 25) at the end of 12 months had significantly lower LDL and RRI values and more allopurinol users than the group with deceasing GFR (74 % vs. 48 %, P < 0.05). In the regression analysis, UA and RRI were found as independent variables (r2 = 0.68, P < 0.01 ; r2 = 0.25, P < 0.01) that affected loss of renal function. We conclude that our study suggests a role for allopurinol, an effective agent in lowering serum UA levels, as a reliable therapeutic option in controlling renal progression in pre-dialysis CKD patients.