Management of Gout and Hyperuricemia in CKD

• Published in: American journal of kidney diseases Vol. 70; no. 3; pp. 422 - 439
• Main Authors: Vargas-Santos, Ana Beatriz, MD, Neogi, Tuhina, MD, PhD, FRCPC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: acute gout; allopurinol; Allopurinol - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; chronic gout; chronic kidney disease; colchicine; Diet Therapy - methods; Disease Management; febuxostat; Febuxostat - administration & dosage; glucocorticoids; gout; Gout - diagnosis; Gout - etiology; Gout - metabolism; Gout - therapy; gout flare; Gout Suppressants - administration & dosage; hemodialysis; Humans; Hyperuricemia; Hyperuricemia - diagnosis; Hyperuricemia - drug therapy; Hyperuricemia - etiology; Hyperuricemia - metabolism; kidney transplant; Male; management; Middle Aged; Nephrology; nonsteroidal anti-inflammatory drugs; Renal Dialysis - adverse effects; Renal Dialysis - methods; renal failure; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - metabolism; Renal Insufficiency, Chronic - therapy; review; Symptom Flare Up; therapy; treatment; Treatment Outcome; urate-lowering therapy; Uric Acid - blood; uricase; uricosurics; nonsteroidal anti-inflammatory drugs; treatment; chronic kidney disease; therapy; kidney transplant; colchicine; uricase; chronic gout; Hyperuricemia; management; gout flare; uricosurics; review; gout; acute gout; renal failure; hemodialysis; urate-lowering therapy; febuxostat; glucocorticoids; allopurinol
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2017.01.055

Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of < 6 mg/dL (or < 5 mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.