Toprover Michael, Crittenden Daria B, Modjinou Dodji V, Oh Cheongeun, Krasnokutsky Svetlana, Fisher Mark C, Keenan Robert T, Pillinger Michael H
Bull Hosp Jt Dis (2013). 2019 Mar;77(2):87-91.
Gout patients with chronic kidney disease (CKD) accumulate the active allopurinol metabolite oxypurinol, suggesting that allopurinol may promote greater serum urate (sU) lowering in CKD patients.
We identified all patientswith gout diagnoses on either 100 mg or 300 mg of allopurinol daily, with available pre- and on-treatment sU levels, in our system in a 1-year period. Mean sU decrement by dosing per CKD groups was determined by CKD stage.
Of 1,288 subjects with gout, 180 met entry criteria, with 83 subjects receiving 100 mg and 97 receiving 300 mg allopurinol. Subjects with CKD stage 1 experienced less sU lowering with 100 mg than 300 mg of allopurinol. Subjects with stage 4 and 5 CKD had equivalent sU decreases across the 100 mg and 300 mg allopurinol groups. However, the 100 mg group started at a higher pre-treatment sU and ended at a higher final sU than the 300 mg group.
The strategy of titrating allopurinol to sU in patients with kidney impairment may result in greater sU lowering at lower doses than in patients without CKD but may also pose a treatment challenge from a possible drug ceiling effect.
慢性肾脏病（CKD）痛风患者会蓄积活性别嘌醇代谢产物氧嘌呤醇，这表明别嘌醇可能会促使CKD患者的血清尿酸（sU）水平有更大幅度降低。
我们在1年时间内，从我们的系统中识别出所有每日服用100毫克或300毫克别嘌醇、有可用的治疗前和治疗期间sU水平且被诊断为痛风的患者。根据CKD分组，通过剂量计算平均sU降低值，并由CKD分期确定。
在1288例痛风患者中，180例符合入选标准，其中83例接受100毫克别嘌醇治疗，97例接受300毫克别嘌醇治疗。CKD 1期患者服用100毫克别嘌醇时的sU降低幅度小于服用300毫克别嘌醇时。CKD 4期和5期患者在100毫克和300毫克别嘌醇组中的sU降低幅度相当。然而，100毫克组治疗前的sU起始值高于300毫克组，治疗后的最终sU值也更高。
在肾功能损害患者中根据sU滴定别嘌醇的策略，可能会使较低剂量时的sU降低幅度大于无CKD的患者，但也可能因可能的药物封顶效应带来治疗挑战。
