The Pattern of Allopurinol Prescription Among Chronic Kidney Disease Patients in a Tertiary Care Centre: A Single-Centre Experience

Sami Alobaidi,1 Naji Dwid,2 Khaldoun Shikh Souk,3 Mohamed Cheikh,4 Ahmed Mandurah,3 Khaled Al-Khatib,3 Ans Ahmed,3 Hani Almoallim5 1Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia; 2Doctor Soliman Fakeeh Hospital, Nephrology Fellow for Saudi Commission for Health Specialties, Jeddah, Saudi Arabia; 3Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 4Doctor Soliman Fakeeh Hospital, Rheumatology Fellow for Saudi Commission for Health Specialties, Jeddah, Saudi Arabia; 5Medical College, Umm Alqura University (UQU), Makkah, 21441, Saudi ArabiaCorrespondence: Sami AlobaidiDepartment of Medicine, University of Jeddah, Jeddah, Saudi ArabiaEmail salobaidi@uj.edu.saContext: Hyperuricemia is prevalent in patients with chronic kidney disease (CKD). Although it is associated with CKD incidence and progression, treating asymptomatic hyperuricemia with uric acid-lowering agents is still debatable.Aim of Work: determine the rate of non-classical prescription of allopurinol in CKD patients.Settings and Design: This was a retrospective study of adult patients prescribed allopurinol with CKD (stages 2– 5) in Doctor Soliman Fakeeh Hospital (DSFH) Jeddah, Saudi Arabia, from 1/1/2016 to 1/1/2017.Subjects and Methods: Eligible patients were identified from the hospital’s pharmacy system and cross-referenced with the electronic health records. Demographic data, laboratory results and indication as recorded by the prescribing physician were extracted. Prescriptions with no indication were categorized based on the uric acid levels. Hyperuricemia was documented as mild (6– 10 mg/dL in females and 7– 13 mg/dL in males) and severe (> 13mg/dL in men and > 10mg/dL in women).Statistical Analysis Used: Descriptive statistics (frequencies, percentages).Results: From the 594 identified patients, 464 (78.1%) were males. A third of prescriptions (209/594) had no indication, 43.5% of which (91/209) had no documented uric acid levels, and 16.3% (34/209) had normal levels. Including patients with undocumented indication, 64.2% (381/594) were prescribed allopurinol for hyperuricemia, 86.4% of which (329/381) had mild hyperuricemia, and only 13.6% (52/381) had severe hyperuricemia. Other indications included malignancy-related disorders (6.2%, 37/594), gouty arthritis (5.2%, 31/594), and stones of unknown aetiology (3.4%, 20/594).Conclusion: The percentage of allopurinol prescription to patients with CKD without a clear indication in our centre was markedly high. This might increase the risk for side effects with no evidence-based benefits.Keywords: allopurinol, gout, hyperuricemia, hyperuricosuria, over prescription, chronic kidney disease