Optimal Administration of Allopurinol in Dialysis Patients

Study Overview
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Brief Summary
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Gout has a strong association with the metabolic syndrome, and it is often seen in patients with renal insufficiency. Allopurinol is a medication intended to lower uric acid and therefore prevents gout attacks. Its metabolism is mainly renal, and some evidence shows that it is also dialyzable. The hypothesis is that allopurinol would be more efficacious to lower uric acid if it was given after dialysis only. The investigators will then switch administration of allopurinol to bedtime for dialysis patients currently taking that medication.

Detailed Description
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Gout has a strong association with the metabolic syndrome, and it is often seen in patients with renal insufficiency. A study has shown an incidence of fifteen percent of gout in the first five years spent in dialysis and it was associated with an increased mortality. Allopurinol is a medication intended to lower uric acid and therefore prevents gout attacks. Its metabolism is mainly renal, and some studies from the early 1960s demonstrated that it is also dialyzable. At the moment, we do not have strong evidence of the optimal dosage of allopurinol with modern techniques of dialysis. The hypothesis is that allopurinol would be more efficacious to lower uric acid if it was given after dialysis only. The investigators will then switch administration of allopurinol to bedtime for dialysis patients currently taking that medication. Dosage of uric acid will be performed to assess the efficacy of the intervention.

Official Title
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Optimal Administration of Allopurinol in Dialysis Patients : A Chronotherapy Trial

Conditions
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Gout, Renal Insufficiency

Intervention / Treatment
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* Drug: Allopurinol


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects who receive chronic treatments of hemodialysis at Maisonneuve-Rosemont Hospital Subjects who take allopurinol for at least a month Exclusion Criteria: Subjects who have had an acute gout attack in the past month Subjects with tumor lysis syndrome Sujects who have a history of hypersensitivity reaction to allopurinol Subjects with hepatic insufficiency Women who are pregnant or planning to become pregnant in the next three months
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Allopurinol HS<br>Allopurinol at bedtime compared to AM administration | Drug: Allopurinol<br>* Administration of allopurinol is changed to bedtime (hs) for each patient, at the same dosage as was previously prescribed.<br>* Other names: Zyloprim;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in uric acid levels from baseline | Compare the efficacy of allopurinol when given before versus after dialysis | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Allopurinol, Renal Dialysis