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The Management of Gout in Renal Disease
Christopher Estiverne1, David B Mount2
1Renal Division, Brigham and Women's Hospital, Boston, MA.
Insights
Gout and hyperuricemia are common in chronic kidney disease (CKD) patients. Managing gout in CKD requires careful consideration of medication risks, with nephrologist involvement crucial for optimal patient outcomes.
Area of Science:
- Nephrology
- Rheumatology
- Clinical Pharmacology
Background:
- Gout affects over 9 million Americans and is linked to hyperuricemia.
- Hyperuricemia is prevalent in chronic kidney disease (CKD) patients, affecting 14% of the US population.
- The relationship between hyperuricemia and CKD progression is under investigation, but treatment for asymptomatic hyperuricemia in CKD lacks robust trial support.
Purpose of the Study:
- To review the data linking CKD, gout, and hyperuricemia.
- To provide practice guidelines for managing gout in CKD patients and kidney transplant recipients.
- To advocate for increased nephrologist involvement in managing renal gout patients.
Main Methods:
- Literature review of existing data on CKD, gout, and hyperuricemia.
- Analysis of pharmacological challenges in treating gout flares and lowering urate in CKD patients.
- Synthesis of information to develop clinical practice guidelines.
Main Results:
- Gout and hyperuricemia present unique challenges in CKD due to increased medication toxicity risks.
- Kidney transplant recipients are especially vulnerable to severe gout and drug-related adverse events.
- Current evidence does not support treating asymptomatic hyperuricemia in CKD based on recent trials.
Conclusions:
- Managing gout in CKD patients, particularly transplant recipients, is complex and necessitates careful drug selection.
- Nephrologists should play a more significant role in the management of gout within the renal patient population.
- Further research may be needed to clarify the benefits of treating hyperuricemia in CKD.
Abstract:
Gout, a debilitating inflammatory arthritis, currently affects more than 9 million Americans. Hyperuricemia, the laboratory abnormality associated with the development of gout, also occurs in a significant number of patients with chronic kidney disease (CKD), a condition that affects approximately 14% of the US population. Several recent studies have attempted to provide a definitive link between the presence of hyperuricemia and progression of CKD; however, the treatment of asymptomatic hyperuricemia in CKD is not supported by recent randomized controlled trials. The pharmacology of acute gout flares and urate lowering is complicated in patients who also have evidence of CKD, primarily because of an increased risk of medication toxicity. Recipients of kidney transplants are particularly at risk of debilitating gout and medication toxicity. We review the available data linking CKD, gout, and hyperuricemia, providing practice guidelines on managing gout in CKD patients and kidney transplant recipients. We advocate for much greater involvement of nephrologists in the management of gout in renal patients.
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