JAMA Internal Medicine 2018;178(11):1526-1533. Association of Chronic Kidney Disease with Allopurinol Use in Gout Treatment Ana Beatriz Vargas-Santos, MD; Christine E. Peloquin, MPH; Yuqing Zhang, DSc; Tuhina Neogi, MD, PhD JAMA Internal Medicine 2018;178(11):1526-1533.

Research Question What is the association of allopurinol use in patients with gout with the risk of developing chronic kidney disease stage 3 or higher?

痛風的成因 尿酸過高 尿酸生成過多 尿酸排除速率過慢 尿酸代謝 異常 尿酸結晶，沉積關節腔 關節炎

Importance Clinicians are often cautious about use of allopurinol in patients with gout when renal function declines there is no evidence that allopurinol is nephrotoxic

Objective   To assess the association of allopurinol use in gout with the risk of developing chronic kidney disease stage 3 or higher.

Study Design time-stratified PSM cohort study data sources: UK GPs (The Health Improvement Network)

Study Design Included Excluded 18-89 years, new dx. gout 2000/1/1−2014/12/31 @ last 1 year Excluded prior CKD stage 3↑ (& ESRD) prior urate-lowering therapy prior other conditions due to time-stratified PSM cohort study design

Outcome definition CKD stage 3+ Dialysis Kidney transplant Death

Statistical analysis Cox proportional hazards model Kaplan-Meier curves Sensitivity analysis censoring at exposure status change included all allopurinol initiators (dose <300 mg/d)

Results

Results

Results

Results

Results

Discussion previous studies about allopurinol … gout studies no significant association with renal function but not directly applicable to gout patients gout studies small sample size or not target for gout (hypertensive) same founding with other studies  potential beneficial

Strengths & Limitations large sample new user design potential confounding observational study potential misclassification suboptimal of gout therapy more compliance for allopurinol user possible detection bias

Conclusion Allopurinol was associated with 13% reduction the risk of developing CKD stage 3+

potential indication bias Comments good topic selection well research design potential indication bias U can do it !

Thanks for your attention Any comments?