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Urate lowering therapy in patients starting hemodialysis limit gout flares occurrence: ten years retrospective study
Alexia Steelandt1, Ambre Hittinger2, Lukshe Kanagaratnam3
1Rheumatology Department, University Hospital of Reims, 45 Rue Cognacq-Jay, Reims, 51100, France.
Insights
Urate-lowering therapy (ULT) significantly reduces gout flares in hemodialysis patients. This finding suggests ULT is a protective factor, aiding in better management of chronic gout in this population.
Area of Science:
- Nephrology
- Rheumatology
- Internal Medicine
Background:
- Uncontrolled gout leads to joint issues and increased mortality, particularly in dialysis patients.
- Existing research on gout flares during hemodialysis and the efficacy of urate-lowering therapy (ULT) is inconclusive.
- There is a lack of clear guidelines for managing chronic gout in hemodialysis patients.
Purpose of the Study:
- To investigate the incidence of gout flares in hemodialysis patients treated with ULT compared to those without treatment.
- To determine if ULT reduces gout flare frequency in patients undergoing hemodialysis.
Main Methods:
- A retrospective cohort study was conducted in two French hemodialysis centers.
- Patients over 18 with a history of gout initiating hemodialysis between January 2005 and September 2015 were included.
- Data on demographics, clinicals, and gout flares (defined by crystal presence or clinical diagnosis with colchicine prescription) were collected over a 5-year follow-up.
Main Results:
- 181 patients were included; 54% received ULT (primarily allopurinol).
- Patients on ULT had significantly fewer gout flares (22.68%) compared to the no-ULT group (50%) (p=0.0002).
- ULT was identified as a protective factor against gout flares (HR: 0.42), and ULT patients achieved target serum urate levels more frequently.
Conclusions:
- Urate-lowering therapy effectively limits new gout flares in hemodialysis patients with a history of gout.
- Collaboration between rheumatologists and nephrologists is recommended to update treatment guidelines for ULT in dialysis patients.
Background:
Uncontrolled gout can cause articular impairment but is also associated with a global and cardiovascular excess mortality, especially in dialysis population. Data documented within existing research is not conclusive regarding gout flares evolution during hemodialysis and their control by urate lowering therapy (ULT). Without clear guidelines concerning hemodialysis patients management with chronic gout, this study proposes to investigate whether gout flare incidence reduction could be observed on this population treated by urate lowering therapy versus patients without treatment.
Methods:
We performed a retrospective cohort study in two hemodialysis centers in France. Were selected patients over 18 years old with a gout history who started hemodialysis between January 2005 and September 2015. Demographics and clinicals data were recorded at hemodialysis start and throughout 5 years of follow up. Gout flare was defined as presence of uric acid crystal in joint punction or clinically diagnosed as such with a colchicine prescription. All statistical analysis were performed in SAS® version 9.4 (SAS Institute Inc., Cary, NC).
Results:
One hundred eighty-one patients have been included, mean age at dialysis initiation was 68.6 years (± 12.4) with 72% of men, 54% were treated by ULT: 89.7% by allopurinol and 9.3% by febuxostat. One patient received both treatments successively. After hemodialysis initiation, 35.36% patients had experienced at least one gout flare. The appearance of at least one gout flare concerned 50% of patients in no ULT group and 22.68% patients in ULT group (p = 0.0002). Dialysis efficiency was measured at regular interval during follow-up and was similar in both groups. To study the association strength between clinical factors and gout flares occurrences, a Cox model was performed; ULT is a protector factor of gout flare (HR:0,42, CI 95: 0,25-0,71). The proportion of serum urate values within the target (median 53% vs 29.3%, p < 0.0001) was significantly higher in ULT group versus no ULT group (median 53% vs 29.3%, p < 0.0001).
Conclusion:
Urate lowering therapy limit new gout flares occurrence in hemodialysis patients with gout historyCollaboration between rheumatologists and nephrologists may help to update guidelines for urate-lowering therapies in patients on dialysis.
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