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Allopurinol Treat-to-Target CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseAllopurinol Treat-to-Target CKDESENeph

A 60-year-old man with CKD G3b has serum urate of 550 umol/L and recurrent gout. He is started on Allopurinol 100 mg daily. After 2 weeks, urate has only fallen to 520 umol/L. What is the recommended approach?

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Correct answer: D — Titrate Allopurinol dose upward every 2-4 weeks to achieve target serum urate <360 umol/L (or <300 umol/L for tophaceous gout)

BSR 2017 and NICE CG169 recommend a treat-to-target strategy for urate-lowering therapy. Allopurinol should be started at a low dose (100 mg, or 50 mg in CKD G4-5) and titrated upward every 2-4 weeks until serum urate target is reached (<360 umol/L, or <300 umol/L for tophaceous gout). In CKD, higher doses than the traditionally recommended renal-adjusted dose may be safe and necessary to achieve target, provided monitoring is performed. The old practice of capping dose at eGFR-based maximums is now considered overly conservative.

Reference: BSR 2017 – Gout; NICE CG169 2022; Stamp et al 2011 – Allopurinol Dose Escalation CKD