1. 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):

2. 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?

3. 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

5. 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

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

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

8. 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

9. Outcome definition
CKD stage 3+
Dialysis
Kidney transplant
Death

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

11. Results

12. Results

13. Results

14. Results

15. Results

16. 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

17. 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

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

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

20. Thanks for your attention Any comments?