A drug commonly used to reduce serum urate levels proved ineffective in slowing disease progression for patients with type 1 diabetes and early-to-moderate diabetic kidney disease, according to findings published in the New England Journal of Medicine.
Higher serum urate levels — high amounts of uric acid in the blood — are associated with the progression of diabetic kidney disease, when kidneys are unable to efficiently eliminate uric acid from the body.
While previous studies have shown that the lowering of serum urate levels with the drug allopurinol in patients with type 2 diabetes reduced the progression of kidney disease, the current findings demonstrated that the drug presented no similar beneficial effects for patients with type 1 diabetes and diabetic kidney disease.
The study was co-authored by two Northwestern faculty: Amisha Wallia, MD, assistant professor of Medicine in the Division of Endocrinology, and Mark Molitch, MD, professor emeritus of Medicine in the Division of Endocrinology.
“This was a well-conducted study that definitively showed a lack of effect of allopurinol for the treatment of diabetic kidney disease. As such, it will serve to prevent further studies in this area,” Molitch said.
For the double-blind trial, the investigators randomly assigned participants with type 1 diabetes and evidence of diabetic kidney disease to receive either allopurinol or a placebo over the course of the three-year study period.
Although participants in the allopurinol group showed a successful lowering of serum uric acid levels, the drug had no overall effect in reducing the progression of diabetic kidney disease.
“It was expected that allopurinol might show a decrease in the rate of progression of kidney disease, but we were surprised that it did not despite allopurinol’s being successful in lowering urate levels,” Molitch said.
This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases grants R03-DK-094484, R34-DK-097808, UC4-DK-101108, P30-DK-036836 and P30-DK-020572; JDRF; the JDRF; the National Center for Advancing Translational Sciences grants UL1-TR-002494, UL1-TR- 001422, UL1-TR-002556, UL1-TR-002319 and UL1-TR- 001105; and the National Institute on Aging grant P30-AG-024824.