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Only 33% of patients with gout are treated with urate-lowering therapy. Allopurinol, the most widely prescribed urate-lowering drug, is avoided in part because some physicians are concerned about prescribing the drug to patients with even mild renal dysfunction; some physicians might also be concerned that allopurinol worsens renal function. However, some studies have shown that urate-lowering therapy can be beneficial for renal function and that gradual dose escalation of allopurinol, even in patients with renal insufficiency, does not raise risk for adverse events (NEJM JW Gen Med Aug 15 2017 and Ann Rheum Dis 2017; 76:1669).
In this population-based cohort study from the U.K., 4760 patients with normal renal function or stage 1 or 2 chron…