TOPLINE

In healthy living kidney donors, 300 mg of allopurinol daily for 9 months led to a significant reduction in uric acid levels but had no effect on left ventricular mass, blood pressure, or insulin sensitivity; adverse events occurred more frequently with allopurinol than with placebo.

METHODOLOGY

• Researchers conducted a phase 2b trial to evaluate whether lowering uric acid levels with 9 months of allopurinol would improve left ventricular mass, blood pressure, or insulin sensitivity in healthy living kidney donors.
• They included 71 healthy kidney donors with an estimated glomerular filtration rate above 30 mL/min/1.73 m² examined at least 6 months post-nephrectomy and randomly assigned them to receive either 300 mg of allopurinol daily or placebo for 9 months.
• The per-protocol analysis included 53 participants who completed 9 months of treatment; of these, 26 participants (mean age, 55 years; 61% women) received allopurinol and 27 (mean age, 55 years; 41% women) received placebo.
• The primary outcome was a change in left ventricular mass from baseline to 9 months, measured using cardiac MRI.
• Secondary outcomes included changes in ambulatory blood pressure, insulin sensitivity, and serum uric acid levels.

TAKEAWAY

• No significant changes from baseline were observed over 9 months in left ventricular mass (P = .106) or left ventricular mass index (P = .067) between the allopurinol and placebo groups; the mean left ventricular ejection fraction also remained unchanged.
• After 9 months, the reduction in uric acid levels was significantly greater in the allopurinol group than in the placebo group (mean change, -102 vs +10 μmol/L; P < .001). 
• No significant differences were observed between the two groups in terms of changes in 24-hour systolic or diastolic blood pressure, insulin sensitivity (measured using the Matsuda index), or fasting insulin levels. 
• Among all 71 participants, 28 reported at least one adverse event (18 in the allopurinol group and 10 in the placebo group); three serious adverse events — drug reaction with eosinophilia and systemic symptoms (resulting in emergency unblinding), angioedema of the lips, and atrial fibrillation — occurred only in the allopurinol group. Minor adverse events included pruritus (n = 2), elevated liver enzymes (n = 3), and diarrhoea (n = 2).

IN PRACTICE

"[The study] found no significant reduction in LVM [left ventricular mass] or blood pressure, nor an association with insulin sensitivity by allopurinol treatment in prevalent healthy kidney donors, despite a significant reduction in uric acid," the authors of the study wrote.

SOURCE

This study was led by Nina Elisabeth Langberg, MD, Oslo University Hospital, Rikshospitalet, Oslo, Norway. It was published online on August 03, 2026, in Kidney360.

LIMITATIONS

The study had a small sample size. Some participants had suboptimal adherence to treatment. Additionally, the 9-month treatment duration may have been too short to observe long-term outcomes.

DISCLOSURES

The study received funding from Helse Sør-Øst RHF, Fondsstiftelsen, Diabetesforbundet, and other sources. Some authors reported receiving research funding or honoraria, serving as employees or consultants, or holding other ties with various pharmaceutical companies or organisations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.