For patients with gout and chronic kidney disease (CKD), no associations with increased mortality were seen for allopurinol initiation, achieving target serum urate (SU) levels, or allopurinol dose escalation, according to a study published in Annals of Internal Medicine. Jie Wei, PhD, and colleagues examined the associations of allopurinol initiation, allopurinol dose escalation, and achieving target SU level (<0.36 mmol/L) after allopurinol initiation with all-cause mortality in patients aged 40 or older with gout and concurrent moderate-to-severe CKD. Among 5,277 allopurinol initiators and 5,277 propensity scorematched non-initiators, mortality rates were 4.9 and 5.8 per 100 person-years, respectively (HR, 0.85; 95% CI, 0.77-0.93). The HR of mortality for achieving the target SU level versus not achieving the target was 0.87 (95% CI, 0.75- 1.01) in the target trial emulation analysis. In the dose escalation group versus no dose escalation, the HR for mortality associated with allopurinol was 0.88 (95% CI, 0.73-1.07).
