How do you approach dosage changes of allopurinol as a patient's GFR decreases over time?

Usually, there is no need to adjust the allopurinol dose for a gradual decline in GFR with aging. The renal dose adjustment for allopurinol is for the initial dose of allopurinol to potentially reduce the risk of allopurinol hypersensitivity (Stamp et al., PMID 22488501). To my knowledge, there are ...

Agree 100%. I also remind them it is not their "fault" and give them handouts from Lancet 10/2019, Rheumatology Advisor 10/2018, and Dr. Lawrence Edwards article from Healio Rheum 11/2019 that remind them it is primarily a genetic predisposition (certainly aggravated by diet) that is the issue. 36 y...