Allopurinol may improve CV outcomes in kidney disease

By Sally Robertson, B.Sc.Feb 8 2013

The xanthine oxidase inhibitor allopurinol appears to be beneficial in preventing cardiovascular (CV) morbidity and all-cause mortality in patients with hypertensive nephropathy, show findings from a Japanese study.

The results suggest that endogenous xanthine oxidase activity may contribute to the progression of macroangiopathy, and that inhibition of this activity has the potential to suppress cardiovascular damage in such patients, say Hiroyuki Terawaki (Fukushima Medical University School of Medicine) and team.

"The cardiovascular risk of CKD [chronic kidney disease] due to hypertension, more specifically hypertensive nephropathy, is significantly higher than that of CKD due to primary glomerular disease," notes the team. "The occurrence of events (cardiovascular disease and all-cause death) in hypertensive nephropathy patients (CKD stage 3-5) is eight times higher than in primary glomerular disease patients."

"Thus, from the viewpoint of preventing cardiovascular mortality and morbidity, it is proposed that hypertensive subjects with lower GFR [glomerular filtration rate] should be paid special attention."

The team conducted a prospective study of 187 patients diagnosed with hypertensive nephropathy and impaired kidney function (estimated GFR <45 mL/min per 1.73 m²). Sixty-seven of these individuals were prescribed allopurinol at baseline, and the patient cohort was followed up every 12 months for a mean of 19.8 months.

As reported in Clinical Experimental Nephropathy, there were 28 CV events and all-cause deaths among the patients. Three individuals had angina pectoris, 10 congestive heart failure, five ischemic stroke, and three hemorrhagic stroke, and seven patients died.

Terewaki and team found that a significantly lower proportion of patients who were prescribed allopurinol experienced a CV event or died compared with those who did not receive the drug, at 10.4% (n=7) versus 18.9% (n=21).

In addition, multivariate analysis showed that individuals who took allopurinol were 60% less likely to have a CV event or die than those who did not.

Allopurinol has previously been shown to decrease levels of C-reactive protein, slow down progression of renal disease, and reduce CV and hospitalization risk in CKD patients, write the researchers.

"If such beneficial effects are also evident in hypertensive subjects with lower GFR, then the CV risk of these subjects may be suppressed with allopurinol."

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