Allopurinol fails to deliver benefit for diabetic renal disease

On the basis that elevated serum urate is associated with an increased risk of diabetic kidney disease, researchers thought that lowering serum urate using allopurinol may slow the decrease in the glomerular filtration rate (GFR) in persons with type 1 diabetes and early-to-moderate diabetic kidney disease.Researchers conducted a double-blind trial, where participants with type 1 diabetes, a serum urate level of at least 4.5 mg per deciliter, an estimated GFR of 40.0 to 99.9 ml per minute per 1.73 m² of body-surface area, and evidence of diabetic kidney disease were randomly assigned to receive allopurinol or placebo. 267 patients were assigned to receive allopurinol and 263 to receive placebo. The mean age was 51.1 years, the mean duration of diabetes 34.6 years, and the mean glycosylated haemoglobin level was 8.2%. The mean baseline GFR was 68.7 ml per minute per 1.73 m² in the allopurinol group and 67.3 ml per minute per 1.73 m² in the placebo group. Allopurinol successfully decreased the mean serum urate relative to placebo, but the rate of decline in GFR did not differ between groups, although the mean urinary albumin excretion rate after washout was 40% (95% CI, 0 to 80) higher with allopurinol than with placebo. Read more here