Effects of Allopurinol on the Progression of Chronic Kidney Disease.
Aged
Allopurinol
/ adverse effects
Diabetes Mellitus, Type 1
/ blood
Diabetic Nephropathies
/ drug therapy
Disease Progression
Double-Blind Method
Enzyme Inhibitors
/ adverse effects
Female
Glomerular Filtration Rate
/ drug effects
Gout Suppressants
/ adverse effects
Humans
Male
Middle Aged
Renal Insufficiency, Chronic
/ drug therapy
Renin-Angiotensin System
Treatment Failure
Uric Acid
/ blood
Xanthine Oxidase
/ antagonists & inhibitors
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
25 06 2020
25 06 2020
Historique:
entrez:
25
6
2020
pubmed:
25
6
2020
medline:
9
7
2020
Statut:
ppublish
Résumé
Elevated serum urate levels are associated with progression of chronic kidney disease. Whether urate-lowering treatment with allopurinol can attenuate the decline of the estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease who are at risk for progression is not known. In this randomized, controlled trial, we randomly assigned adults with stage 3 or 4 chronic kidney disease and no history of gout who had a urinary albumin:creatinine ratio of 265 or higher (with albumin measured in milligrams and creatinine in grams) or an eGFR decrease of at least 3.0 ml per minute per 1.73 m Enrollment was stopped because of slow recruitment after 369 of 620 intended patients were randomly assigned to receive allopurinol (185 patients) or placebo (184 patients). Three patients per group withdrew immediately after randomization. The remaining 363 patients (mean eGFR, 31.7 ml per minute per 1.73 m In patients with chronic kidney disease and a high risk of progression, urate-lowering treatment with allopurinol did not slow the decline in eGFR as compared with placebo. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; CKD-FIX Australian New Zealand Clinical Trials Registry number, ACTRN12611000791932.).
Sections du résumé
BACKGROUND
Elevated serum urate levels are associated with progression of chronic kidney disease. Whether urate-lowering treatment with allopurinol can attenuate the decline of the estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease who are at risk for progression is not known.
METHODS
In this randomized, controlled trial, we randomly assigned adults with stage 3 or 4 chronic kidney disease and no history of gout who had a urinary albumin:creatinine ratio of 265 or higher (with albumin measured in milligrams and creatinine in grams) or an eGFR decrease of at least 3.0 ml per minute per 1.73 m
RESULTS
Enrollment was stopped because of slow recruitment after 369 of 620 intended patients were randomly assigned to receive allopurinol (185 patients) or placebo (184 patients). Three patients per group withdrew immediately after randomization. The remaining 363 patients (mean eGFR, 31.7 ml per minute per 1.73 m
CONCLUSIONS
In patients with chronic kidney disease and a high risk of progression, urate-lowering treatment with allopurinol did not slow the decline in eGFR as compared with placebo. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; CKD-FIX Australian New Zealand Clinical Trials Registry number, ACTRN12611000791932.).
Identifiants
pubmed: 32579811
doi: 10.1056/NEJMoa1915833
doi:
Substances chimiques
Enzyme Inhibitors
0
Gout Suppressants
0
Uric Acid
268B43MJ25
Allopurinol
63CZ7GJN5I
Xanthine Oxidase
EC 1.17.3.2
Banques de données
ANZCTR
['ACTRN12611000791932']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2504-2513Subventions
Organisme : National Health and Medical Research Council
ID : APP1043203
Pays : International
Organisme : Health Research Council of New Zealand
ID : 14/117
Pays : International
Investigateurs
David W Johnson
(DW)
Sunil V Badve
(SV)
Anushree Tiku
(A)
Neil Boudville
(N)
Fiona G Brown
(FG)
Alan Cass
(A)
Philip Clarke
(P)
Nicola Dalbeth
(N)
Richard O Day
(RO)
Janak de Zoysa
(J)
Bettina Douglas
(B)
Randall Faull
(R)
David C Harris
(DC)
Carmel M Hawley
(CM)
Graham R D Jones
(GRD)
John Kanellis
(J)
Suetonia C Palmer
(SC)
Elaine M Pascoe
(EM)
Vlado Perkovic
(V)
Gopala K Rangan
(GK)
Donna Reidlinger
(D)
Laura Robison
(L)
Robert J Walker
(RJ)
Giles Walters
(G)
Bruce Neal
(B)
Andrew Forbes
(A)
David C Wheeler
(DC)
Christoph Wanner
(C)
Elaine Pascoe
(E)
Liza A Vergara
(LA)
Peta-Anne Paul-Brent
(PA)
Julie Varghese
(J)
Alicia T Morrish
(AT)
Anish Scaria
(A)
Andrea K Viecelli
(AK)
Charani Kiriwandeniya
(C)
Hayley B Candler
(HB)
Magid A Fahim
(MA)
Rathika Krishnasamy
(R)
Yeoungjee Cho
(Y)
Alicia Morrish
(A)
Tony Merriman
(T)
Elizabeth Phillips
(E)
Patricia Johnson
(P)
Simon Roger
(S)
Liz Bohringer
(L)
Emmanuel D'Almeida
(E)
Leanne Garvey
(L)
Theresa Brown
(T)
Bhadran Bose
(B)
Nelson Ubera
(N)
Craig Lawlor
(C)
Grant Luxton
(G)
Jacqueline Pearse
(J)
Zuzana Gray
(Z)
Natalie Murphy
(N)
Maham Amin
(M)
George Mangos
(G)
Kylie Turner
(K)
Paula Williamson
(P)
Gopala Rangan
(G)
David Harris
(D)
Penelope Murie
(P)
Myrna Llapitan
(M)
Jane Holt
(J)
Mikki Smyth
(M)
Siddharth Sharma
(S)
Helen McEvoy
(H)
Krishan Madhan
(K)
Leanne Brown
(L)
Ada Stevenson
(A)
Ken-Soon Tan
(KS)
Erica Lennan
(E)
Carolyn Clark
(C)
Andrea Pollock
(A)
Gerald Hilder
(G)
David Johnson
(D)
Amanda Coburn
(A)
Joanna Sudak
(J)
Sree Krishna Venuthurupalli
(SK)
Ian Fox
(I)
George Passaris
(G)
Susan Murray
(S)
Margaret Pummeroy
(M)
Jenny Latte
(J)
Lisa Jeffs
(L)
Matthew Jose
(M)
Kathy Paizis
(K)
Marieke Veenendaal
(M)
Fiona Brown
(F)
Teresa Gilley
(T)
David Packham
(D)
Robyn Gibbs
(R)
Scott Wilson
(S)
Jacquie Dixon
(J)
Claire Galbraith
(C)
Craig Nelson
(C)
Jason Bennier
(J)
Ashley Irish
(A)
Monika Chang
(M)
John Collins
(J)
Michael Collins
(M)
Andrew Pilmor
(A)
Jenny Usher
(J)
Nick Cross
(N)
Suetonia Palmer
(S)
Erin Baker
(E)
Beula Vincent
(B)
Ashik Hayat
(A)
Lynette Knuth
(L)
Rob Walker
(R)
Liz Berry
(L)
Ines Becker
(I)
Kannaiyan Rabindranath
(K)
Deborah Peek
(D)
Tania Smith
(T)
Walaa Saweirs
(W)
Christine Johnson
(C)
Commentaires et corrections
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Informations de copyright
Copyright © 2020 Massachusetts Medical Society.