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Two recent randomized trials showed that allopurinol conferred no beneficial effect on renal function in patients without gout but with elevated serum urate levels and documented kidney disease (NEJM JW Gen Med Jul 15 2020 and N Engl J Med 2020; 382:2493, 2504); pooled analysis from these studies showed a nonsignificant trend toward higher early mortality in patients who received allopurinol. To explore this issue further, British investigators conducted a retrospective cohort study of patients (mean age, 74) with gout and chronic kidney disease (CKD; stage 3 or greater). They used propensity-score matching to compare >5000 recent initiators of allopurinol to a similar number of noninitiators. Follow-up was 5 years.
Allopurinol initiators ha…