Management of Gout and Hyperuricemia in CKD

Am J Kidney Dis. 2017 Sep;70(3):422-439. doi: 10.1053/j.ajkd.2017.01.055. Epub 2017 Apr 26.

Abstract

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 <6mg/dL (or <5mg/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.

Keywords: Hyperuricemia; acute gout; allopurinol; chronic gout; chronic kidney disease; colchicine; febuxostat; glucocorticoids; gout; gout flare; hemodialysis; kidney transplant; management; nonsteroidal anti-inflammatory drugs; renal failure; review; therapy; treatment; urate-lowering therapy; uricase; uricosurics.

Publication types

  • Case Reports

MeSH terms

  • Allopurinol / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Diet Therapy / methods
  • Disease Management
  • Febuxostat / administration & dosage*
  • Gout Suppressants / administration & dosage
  • Gout* / diagnosis
  • Gout* / etiology
  • Gout* / metabolism
  • Gout* / therapy
  • Humans
  • Hyperuricemia* / diagnosis
  • Hyperuricemia* / drug therapy
  • Hyperuricemia* / etiology
  • Hyperuricemia* / metabolism
  • Male
  • Middle Aged
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / methods
  • Renal Insufficiency, Chronic* / complications
  • Renal Insufficiency, Chronic* / diagnosis
  • Renal Insufficiency, Chronic* / metabolism
  • Renal Insufficiency, Chronic* / therapy
  • Symptom Flare Up
  • Treatment Outcome
  • Uric Acid / blood

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Gout Suppressants
  • Febuxostat
  • Uric Acid
  • Allopurinol