Treatment with Allopurinol is associated with lower risk of acute kidney injury in patients with gout: A retrospective analysis of a nested cohort

Acute kidney injury (AKI) is the most severe adverse effects reported by nonsteroidal anti-inflammatory drugs (NSAIDs). This cohort study evaluated the risk factors associated with AKI on gout patients who were exposed to NSAIDs and significantly lower the risk of AKI with concomitant use of allopurinol. 

To assess the risk factors linked with acute kidney injury (AKI) ascribed to NSAIDs in a cohort of participants who were exposed to NSAIDs to control gout flares before urate-lowering treatment.

A total of 983 patients with variables associated with gout and its severity (number for flares per year, serum urate levels, previous urate-lowering therapy, X-ray involvement,  joint distribution, and presence of tophi) and general variables ( gender, age, ethanol intake, diuretic use, hyperlipidemia,  hypertension, renal function,diabetes, and vascular events) were selected for the retrospective analysis. The loss of renal function ascribed to NSAID as per the RIFLE classification for (risk, injury, and failure) for acute renal events was taken as the study outcomes. By utilising time from start of gout to the event as time exposed to NSAIDs, multivariable Cox survival analysis examined the variables correlated with enhanced risk in Kaplan–Meier survival analysis.

A total of 55 out of 983 participants felt AKI; the number of flares in the year prior to the polyarticular joint distribution and renal event were linked with greater risk of renal events. Other variables earlier expressed in the literature, such as the presence of previous vascular events, use of diuretics, and previous chronic renal disease were also related independently with an enhanced risk of AKI. Interestingly, participants who had been earlier adviced Allopurinol presented a lower risk of acute renal events.

Along with classic risk factors, the extensive joint distribution and the number of flares were related with greater risk for renal injury among people with gout, whereas the earlier prescription of Allopurinol was linked with lower risk.