Canada Chronic renal failure: allopurinol considered ineffective!

09:50  30 june  2020
09:50  30 june  2020 Source:   medisite.fr

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Pathophysiology of chronic renal failure . Regardless of the primary cause of nephron loss, some usually survive or are less severely damaged. Although the metabolic acidosis of CRF is commonly referred to as an anion gap acidosis, this gap does not develop until the serum creatinine

Chronic kidney disease (CKD) is initially described as diminished renal reserve or renal insufficiency, which may progress to renal failure (end-stage renal disease ). Initially, as renal tissue loses function, there are few noticeable abnormalities because the remaining tissue increases its performance

Insuffisance rénale chronique : l’allopurinol jugé inefficace ! © Istock Chronic renal failure: allopurinol considered ineffective!

If there is no curative treatment for chronic renal failure, it is sometimes possible to slow its progression. It was believed, in particular, that the drug allopurinol was able to slow down the decline in kidney function. A major clinical trial has just proved the contrary: this molecule is, in reality, ineffective in the treatment of this pathology.

In France, nearly 3 million people suffer from chronic kidney disease , which prevents the kidneys from properly filtering waste. Almost 90,000 patients are even at the stage of end-stage renal disease (CKD), a serious pathology that requires treatment with dialysis or an kidney transplant , according to the France Rein network.

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Chronic renal failure , or chronic kidney disease (CKD), is a slow and progressive decline of kidney function. Unlike acute renal failure , which happens quickly and suddenly, chronic renal failure happens gradually – over a period of weeks, months, or years – as the kidneys slowly stop working

Chronic kidney disease affects renal drug elimination and other pharmacokinetic processes Drug dosing errors are common in patients with renal impairment and can cause adverse effects and Drug Prescribing in Renal Failure : Dosing Guidelines for Adults. Publisher: American College of Physicians.

If scientific studies sometimes bring us good news, with the hope of new treatments, this is unfortunately not always the case. An Australian clinical trial reveals that the drug allopurinol , which is prescribed to approximately 20% of patients with chronic renal failure, does not work as it should. The results were published on June 25, 2020 in the New England Journal of Medicine.

Allopurinol does not slow down the deterioration of the kidneys

Allopurinol is, originally, a treatment used to treat gout and kidney stones . It works by decreasing the production of uric acid, which lowers its levels in the blood and urine.

Researchers from the University of New South Wales, the George Institute for Global Health and the Australasian Kidney Trials Network, examined data from ,369 patients with chronic renal failure for 2 years . These patients were followed in 31 hospitals in Australia and New Zealand, and all were at risk of developing more serious illness.

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Renal failure is also frequently associated with gouty nephropathy and rarely with hypersensitivity reactions associated with Allopurinol tablets. Albuminuria has been observed among patients who developed clinical gout following chronic glomerulonephritis and chronic pyelonephritis.

Allopurinol in renal failure and the tumor lysis syndrome. The diagnosis GBS was considered , which was supported by spinal fluid investigation and electromyography. None developed renal failure , and there were no adverse outcomes on follow-up.

Some of them were placed on allopurinol , the other group on placebo . The scientists then analyzed the rate at which their kidney function deteriorated over time. "We found that kidney function declined at a similar rate in patients receiving allopurinol and those receiving placebo," said Sunil Badve, who co-led the study.

Too high uric acid level: a simple marker of kidney failure

Based on previous work, scientists thought that allopurinol could reduce the progression rate of chronic kidney disease. In fact, three-quarters of people who suffer from it have high levels of uric acid in the blood. So they assumed these were correlated with the risk of kidney failure, and that reducing these rates with allopurinol could delay the progression of the disease.

Nevertheless, the fact that the disease progresses as quickly in patients on allopurinol, as in those belonging to the control group, seems to prove the opposite . In other words, the theory that high blood levels of uric acid cause faster deterioration in kidney function is surely false . Professor Badve suggests that they are, quite simply, a marker of kidney failure.

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