ArticleNephrology (Carlton, Vic.)2026
Reduced Serum Urate Concentrations Despite Unchanged Allopurinol Dosing in Gout Patients Commenced on Dialysis: A Retrospective Chart Review.
Article in Nephrology (Carlton, Vic.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimPeople with kidney failure are at increased risk of gout-related hospitalisations and mortality. Whilst dialysis enhances urate removal and reduces circulating oxypurinol (allopurinol's active metabolite), its effect on achieving target serum urate concentrations (< 0.36 mmol/L) and implications for gout management remain unclear. This study aimed to evaluate serum urate concentrations and allopurinol dosing following commencement of dialysis.
methodsWe conducted a retrospective chart review of adults prescribed allopurinol at a dialysis Centre in New South Wales, Australia, between 01/06/2019 and 30/06/2024. Eligible patients had at least one serum urate concentration recorded after commencing dialysis. Data collected included patient demographics, dialysis modality, allopurinol dosing, and serum urate concentrations, spanning from pre-dialysis to up to 5 years post-commencing dialysis.
resultsForty-five patients (18 haemodialysis [HD], 27 peritoneal dialysis [PD]) were included. Most HD patients (61%) received thrice-weekly haemodiafiltration with high-flux dialysers; 59% of PD patients used automated PD. Allopurinol doses (100-300 mg daily, mostly 100 mg) remained unchanged from pre-dialysis in 93% (42/45). At 4 (0.25-38) months post-dialysis, median serum urate concentrations declined compared to pre-commencing dialysis (HD: 0.31 vs. 0.51 mmol/L, p = 0.031; PD: 0.33 vs. 0.53 mmol/L, p < 0.001). Target serum urate concentrations were reached at least once in 60% of HD and 78% of PD patients.
conclusionSerum urate concentrations declined after starting dialysis with unchanged allopurinol dosing, suggesting dialysis independently contributes to urate reduction. These findings support re-evaluating allopurinol dose in patients after commencing dialysis, including de-prescribing allopurinol in those who consistently achieve target urate concentrations.
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