Medicine Service, Birmingham VA Medical Center, Birmingham, Alabama, USA.
Division of Epidemiology, Department of Medicine School of Medicine, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.
Ann Rheum Dis. 2017 Jan;76(1):133-139. doi: 10.1136/annrheumdis-2015-209046. Epub 2016 Jun 13.
To assess the effect of allopurinol dose/duration on the risk of renal failure in the elderly with allopurinol use.
We used the 5% random Medicare claims data from 2006 to 2012. Multivariable-adjusted Cox regression analyses assessed the association of allopurinol dose/duration with subsequent risk of developing incident renal failure or end-stage renal disease (ESRD) (no prior diagnosis in last 183 days) in allopurinol users, controlling for age, sex, race and Charlson-Romano comorbidity index. HRs with 95% CIs were calculated. Sensitivity analyses considered a longer baseline period (365 days), controlled for gout or used more specific codes.
Among the 30 022 allopurinol treatment episodes, 8314 incident renal failure episodes occurred. Compared with 1-199 mg/day, allopurinol dose of 200-299 mg/day (HR 0.81; 95% CI 0.75 to 0.87) and ≥300 mg/day, 0.71 (0.67 to 0.76), had significantly lower hazard of renal failure in multivariable-adjustment model, confirmed in multiple sensitivity analyses. Longer allopurinol use duration was significantly associated with lower hazards in sensitivity analyses (365-day look-back; reference, <0.5 year): 0.5-1 year, 1.00 (0.88, 1.15); >1-2 years, 0.85 (0.73 to 0.99); and >2 years, 0.81 (0.67 to 0.98). Allopurinol ≥300 mg/day was also associated with significantly lower risk of acute renal failure and ESRD with HR of 0.89 (0.83 to 0.94) and 0.57 (0.46 to 0.71), respectively.
Higher allopurinol dose is independently protective against incident renal failure in the elderly allopurinol users. A longer duration of allopurinol use may be associated with lower risk of incident renal failure. Potential mechanisms of these effects need to be examined.
评估别嘌醇剂量/持续时间对老年别嘌醇使用者发生肾衰竭的风险的影响。
我们使用了 2006 年至 2012 年的 5%随机 Medicare 理赔数据。多变量调整的 Cox 回归分析评估了别嘌醇剂量/持续时间与随后发生的事件性肾衰竭或终末期肾病（ESRD）（在过去 183 天内无先前诊断）风险之间的关联，同时控制了年龄、性别、种族和 Charlson-Romano 合并症指数。计算了 95%CI 的 HR。敏感性分析考虑了更长的基线期（365 天），控制了痛风或使用了更具体的代码。
在 30022 例别嘌醇治疗病例中，发生了 8314 例肾衰竭事件。与 1-199mg/天相比，200-299mg/天（HR 0.81；95%CI 0.75 至 0.87）和≥300mg/天（HR 0.71；0.67 至 0.76）的别嘌醇剂量与多变量调整模型中的肾衰竭风险显著降低，在多次敏感性分析中得到了证实。更长的别嘌醇使用时间与敏感性分析中的较低风险显著相关（365 天回顾；参考，<0.5 年）：0.5-1 年，1.00（0.88，1.15）；>1-2 年，0.85（0.73 至 0.99）；>2 年，0.81（0.67 至 0.98）。别嘌醇剂量≥300mg/天也与急性肾衰竭和 ESRD 的风险显著降低相关，风险比（HR）分别为 0.89（0.83 至 0.94）和 0.57（0.46 至 0.71）。
较高的别嘌醇剂量与老年别嘌醇使用者的事件性肾衰竭独立相关。更长的别嘌醇使用时间可能与较低的事件性肾衰竭风险相关。需要进一步研究这些影响的潜在机制。
