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Preventing Early Renal Loss in Diabetes (PERL) evaluates whether lowering SUA with allopurinol slows glomerular filtration rate (GFR) loss in people with type 1 diabetes (T1D) and mild to moderate DKD. We present the PERL rationale, design, and baseline characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>This double-blind, placebo-controlled, multicenter trial randomized 530 participants with T1D, estimated GFR (eGFR) of 40\u201399.9 mL\/min\/1.73 m2, SUA \u22654.5 m\/dL, and micro- to macroalbuminuric DKD or normoalbuminuria with declining kidney function (NDKF) (defined as historical eGFR decline \u22653 mL\/min\/1.73 m2\/year) to allopurinol or placebo. The primary outcome is baseline-adjusted iohexol GFR (iGFR) after 3 years of treatment plus a 2-month washout period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Participants are 66% male and 84% white. At baseline, median age was 52 years and diabetes duration was 35 years, 93% of participants had hypertension, and 90% were treated with renin-angiotensin system inhibitors (median blood pressure 127\/71 mmHg). Median HbA1c was 8%, SUA 5.9 mg\/dL, iGFR 68 mL\/min\/1.73 m2, and historical eGFR slope \u22123.5 mL\/min\/1.73 m2\/year. Compared with participants with albuminuria (n = 419), those with NDKF (n = 94) were significantly older (56 vs. 52 years), had lower HbA1c (7.7 vs. 8.1%) and SUA (5.4 vs. 6.0 mg\/dL), and had higher eGFR (82 vs. 74 mL\/min\/1.73 m2) and historical eGFR loss (\u22124.7 vs. \u22122.5 mL\/min\/1.73 m2\/year). These differences persisted when comparing groups with similar rates of historical eGFR loss.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>PERL will determine the effect of allopurinol on mild to moderate DKD in T1D, with or without albuminuria. Participants with normoalbuminuria and rapid GFR loss manifested many DKD risk factors of those with albuminuria, but with less severity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc19-0342","type":"journal-article","created":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T23:05:20Z","timestamp":1560294320000},"page":"1454-1463","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":44,"title":["Preventing Early Renal Loss in Diabetes (PERL) Study: A Randomized Double-Blinded Trial of Allopurinol\u2014Rationale, Design, and Baseline Data"],"prefix":"10.2337","volume":"42","clinical-trial-number":[{"clinical-trial-number":"nct02017171","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8428-8264","authenticated-orcid":false,"given":"Maryam","family":"Afkarian","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of California, Davis, Davis, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7602-0396","authenticated-orcid":false,"given":"Sarit","family":"Polsky","sequence":"additional","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afshin","family":"Parsa","sequence":"additional","affiliation":[{"name":"Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8976-2321","authenticated-orcid":false,"given":"Ronnie","family":"Aronson","sequence":"additional","affiliation":[{"name":"LMC Diabetes & Endocrinology, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Luiza","family":"Caramori","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4164-0429","authenticated-orcid":false,"given":"David Z.","family":"Cherney","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill P.","family":"Crandall","sequence":"additional","affiliation":[{"name":"Department of Medicine, Albert Einstein College of Medicine, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1571-7592","authenticated-orcid":false,"given":"Ian H.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Washington, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4626-6440","authenticated-orcid":false,"given":"Thomas G.","family":"Elliott","sequence":"additional","affiliation":[{"name":"BCDiabetes, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrzej T.","family":"Galecki","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Institute of Gerontology, University of Michigan, Ann Arbor, MI"},{"name":"Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison B.","family":"Goldfine","sequence":"additional","affiliation":[{"name":"Research Division, Joslin Diabetes Center, and Department of Medicine, Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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