Kidney medication ineffective

A major clinical trial has found the drug Allopurinol does not prevent worsening of kidney disease.

University of Queensland researchers at the Translational Research Institute have found Allopurinol is ineffective in treating the condition, despite up to 20 per cent of kidney disease patients being prescribed the medication. 

Queensland Kidney Transplant Service Medical Director Professor David Johnson, who is based at Brisbane's PA Hospital, said until now there had been little robust evidence to demonstrate Allopurinol’s benefit in slowing kidney disease.

“Our study compared the use of Allopurinol to a placebo and found, to our surprise, that it made no difference to the rate of kidney function decline,” Professor Johnson said.

“Based on these results, we believe there is no benefit in prescribing this medication, unless there is an additional specific medical reason, such as gout.”

Allopurinol was originally developed to treat gout, but for the past 20 years doctors have also used it to prevent the decline of kidney function in chronic kidney disease.

Professor Johnson said it was important that people taking Allopurinol to lower blood urate levels did not abruptly stop the treatment, but first discussed their kidney care management with a doctor.

The two-year study, conducted with the Australasian Kidney Trials Network, ran across 31 hospitals in Australia and New Zealand and involved 369 patients with stage 3 or 4 chronic kidney disease and at increased risk of kidney disease progression.

NZ lead investigator Dr Janak de Zoysa, Clinical Director of the Waitemata Renal Service, said the study would allow doctors to optimise clinical practice.

"Treatments that are proven not to be as effective as anticipated allow room for them to be stopped or not started in the first place, reducing unnecessary healthcare costs,” Dr de Zoysa said.

Approximately 1.7 million Australians and 400,000 New Zealanders aged 18 years and older have chronic kidney disease.

Senior Research Fellow at The George Institute for Global Health and nephrologist at St George Hospital, Associate Professor Sunil Badve, study co-lead, said the widely held view that elevated blood urate levels were responsible for rapid decline of kidney function was probably wrong.

“Based on our results, it appears elevated blood urate levels are more likely an indicator of reduced kidney function, rather than a cause of reduced kidney function,” he said.

This study was funded by the National Health and Medical Research Council and the Health and Research Council of New Zealand, and  published in The New England Journal of Medicine (DOI: 10.1056/NEJMoa1915833).

Media: Professor David Johnson, david.johnson@uq.edu.au, Faculty of Medicine Communications, med.media@uq.edu.au, +61 7 3365 5133, +61 436 368 746.