PubMed:29268756 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PubMed/sourceid/29268756","sourcedb":"PubMed","sourceid":"29268756","source_url":"https://www.ncbi.nlm.nih.gov/pubmed/29268756","text":"The effect of kidney function on the urate lowering effect and safety of increasing allopurinol above doses based on creatinine clearance: a post hoc analysis of a randomized controlled trial.\nBACKGROUND: The use of allopurinol in people with chronic kidney disease (CKD) remains one of the most controversial areas in gout management. The aim of this study was to determine the effect of baseline kidney function on safety and efficacy of allopurinol dose escalation to achieve serum urate (SU) \u003c6 mg/dl.\nMETHODS: We undertook a post hoc analysis of a 24-month allopurinol dose escalation treat-to-target SU randomized controlled trial, in which 183 people with gout were randomized to continue current dose allopurinol for 12 months and then enter the dose escalation phase or to begin allopurinol dose escalation immediately. Allopurinol was increased monthly until SU was \u003c6 mg/dl. The effect of baseline kidney function on urate lowering and adverse effects was investigated.\nRESULTS: Irrespective of randomization, there was no difference in the percentage of those with creatinine clearance (CrCL) \u003c30 ml/min who achieved SU \u003c6 mg/dl at the final visit compared to those with CrCL ≥30 to \u003c60 ml/min and those with CrCL ≥60 ml/min, with percentages of 64.3% vs. 76.4% vs. 75.0%, respectively (p = 0.65). The mean allopurinol dose at month 24 was significantly lower in those with CrCL \u003c30 ml/min as compared to those with CrCL ≥30 to \u003c60 ml/min or CrCL ≥60 ml/min (mean (SD) 250 (43), 365 (22), and 460 (19) mg/day, respectively (p \u003c 0.001)). Adverse events were similar among groups.\nCONCLUSIONS: Allopurinol is effective at lowering urate even though and accepting that there were small numbers of participants with CrCL \u003c30 ml/min, these data indicate that allopurinol dose escalation to target SU is safe in people with severe CKD. The dose required to achieve target urate is higher in those with better kidney function.\nTRIAL REGISTRATION: Australian and New Zealand Clinical trials Registry, ACTRN12611000845932 . Registered on 10 August 2011.","tracks":[{"project":"Zierdiyeerkenaili_800","denotations":[{"id":"T2","span":{"begin":216,"end":227},"obj":"CI"},{"id":"T3","span":{"begin":440,"end":451},"obj":"CI"},{"id":"T4","span":{"begin":562,"end":573},"obj":"CI"},{"id":"T5","span":{"begin":709,"end":720},"obj":"CI"},{"id":"T6","span":{"begin":788,"end":799},"obj":"CI"},{"id":"T7","span":{"begin":1319,"end":1330},"obj":"CI"},{"id":"T8","span":{"begin":1766,"end":1777},"obj":"CI"},{"id":"T9","span":{"begin":84,"end":95},"obj":"CI"},{"id":"T10","span":{"begin":251,"end":265},"obj":"DP"},{"id":"T11","span":{"begin":267,"end":270},"obj":"DP"},{"id":"T12","span":{"begin":1837,"end":1840},"obj":"DP"}],"attributes":[{"subj":"T2","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T3","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T4","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T5","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T6","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T7","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T8","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T9","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T10","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T11","pred":"source","obj":"Zierdiyeerkenaili_800"},{"subj":"T12","pred":"source","obj":"Zierdiyeerkenaili_800"}]},{"project":"Zierdiyeerkenaili_800_3","denotations":[{"id":"T1","span":{"begin":663,"end":667},"obj":"DP"},{"id":"T2","span":{"begin":319,"end":323},"obj":"DP"},{"id":"T3","span":{"begin":709,"end":720},"obj":"CI"},{"id":"T4","span":{"begin":84,"end":95},"obj":"CI"},{"id":"T5","span":{"begin":216,"end":227},"obj":"CI"},{"id":"T6","span":{"begin":440,"end":451},"obj":"CI"},{"id":"T7","span":{"begin":562,"end":573},"obj":"CI"},{"id":"T8","span":{"begin":788,"end":799},"obj":"CI"},{"id":"T9","span":{"begin":1319,"end":1330},"obj":"CI"},{"id":"T10","span":{"begin":1766,"end":1777},"obj":"CI"}],"attributes":[{"subj":"T1","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T2","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T3","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T4","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T5","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T6","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T7","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T8","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T9","pred":"source","obj":"Zierdiyeerkenaili_800_3"},{"subj":"T10","pred":"source","obj":"Zierdiyeerkenaili_800_3"}]},{"project":"yaoziqian_800_3","denotations":[{"id":"T1","span":{"begin":84,"end":95},"obj":"CI"},{"id":"T2","span":{"begin":216,"end":227},"obj":"CI"},{"id":"T3","span":{"begin":440,"end":451},"obj":"CI"},{"id":"T4","span":{"begin":562,"end":573},"obj":"CI"},{"id":"T5","span":{"begin":709,"end":720},"obj":"CI"},{"id":"T6","span":{"begin":788,"end":799},"obj":"CI"},{"id":"T7","span":{"begin":1319,"end":1330},"obj":"CI"},{"id":"T8","span":{"begin":1766,"end":1777},"obj":"CI"},{"id":"T9","span":{"begin":319,"end":323},"obj":"DP"},{"id":"T10","span":{"begin":663,"end":667},"obj":"DP"}],"attributes":[{"subj":"T1","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T2","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T3","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T4","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T5","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T6","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T7","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T8","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T9","pred":"source","obj":"yaoziqian_800_3"},{"subj":"T10","pred":"source","obj":"yaoziqian_800_3"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"Zierdiyeerkenaili_800","color":"#ec9693","default":true},{"id":"Zierdiyeerkenaili_800_3","color":"#93aaec"},{"id":"yaoziqian_800_3","color":"#c4ec93"}]}]}}