From the Guidelines
Hyperuricemia should be addressed through lifestyle modifications and possibly medication, with the goal of reducing uric acid levels to prevent gout attacks, kidney stones, kidney disease, and increased cardiovascular risk. The implications of hyperuricemia are significant, as it can lead to the formation of monosodium urate crystals in joints, causing painful gout attacks, and may contribute to other health issues such as kidney stones, kidney disease, and increased cardiovascular risk 1.
Lifestyle Modifications
To manage hyperuricemia, it is essential to make lifestyle changes, including:
- Reducing purine-rich foods like red meat, organ meats, seafood, and alcohol (especially beer) 1
- Increasing water intake to at least 2-3 liters daily to help flush uric acid from the system
- Maintaining a healthy weight, as obesity increases uric acid production
Medication
For medication, xanthine oxidase inhibitors, such as allopurinol or febuxostat, are preferred over uricosuric agents for people with chronic kidney disease (CKD) and symptomatic hyperuricemia 1. The typical starting dose of allopurinol is 100mg daily, which can be increased to 300-600mg daily based on uric acid levels and kidney function. Febuxostat (40-80mg daily) is an alternative for those who cannot tolerate allopurinol. During initial treatment, colchicine (0.6mg once or twice daily) may be prescribed to prevent gout flares. For acute gout attacks, low-dose colchicine or intra-articular/oral glucocorticoids are preferable to nonsteroidal anti-inflammatory drugs (NSAIDs) for symptomatic treatment of acute gout flare 1.
Monitoring and Treatment
Regular monitoring of uric acid levels is essential, aiming for levels below 6 mg/dL. Uric acid-lowering intervention is recommended for people with CKD and symptomatic hyperuricemia 1. Consider initiating uric acid-lowering therapy for people with CKD after their first episode of gout, particularly where there is no avoidable precipitant or serum uric acid concentration is >9 mg/dl [535 μmol/l] 1.
Key Considerations
It is crucial to consider the individual's overall health, including the presence of CKD, when managing hyperuricemia. The FDA-approved dosing for colchicine is 1.2 mg followed by 0.6 mg an hour later for acute flares 1. By addressing hyperuricemia through lifestyle modifications and medication, individuals can reduce their risk of developing gout and other related health issues, ultimately improving their quality of life and reducing morbidity and mortality.
From the FDA Drug Label
Hyperuricemia may be primary, as in gout, or secondary to diseases such as acute and chronic leukemia, polycythemia vera, multiple myeloma, and psoriasis It may occur with the use of diuretic agents, during renal dialysis, in the presence of renal damage, during starvation or reducing diets, and in the treatment of neoplastic disease where rapid resolution of tissue masses may occur. Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys.
The implications of hyperuricemia (elevated uric acid) include:
- Gout and gouty arthritis
- Deposition of monosodium urate in the tissues, particularly the joints and kidneys
- Potential occurrence due to various diseases such as:
- Acute and chronic leukemia
- Polycythemia vera
- Multiple myeloma
- Psoriasis
- Potential occurrence due to other factors such as:
- Use of diuretic agents
- Renal dialysis
- Renal damage
- Starvation or reducing diets
- Treatment of neoplastic disease 2
From the Research
Implications of Hyperuricemia
The implications of hyperuricemia, or elevated uric acid, are numerous and can have significant effects on various bodily systems. Some of the key implications include:
- Increased risk of chronic kidney disease (CKD) progression, as hyperuricemia may contribute to the development or worsening of CKD 3, 4, 5
- Association with hypertension, as uric acid levels are higher in individuals with hypertension and may contribute to the development of salt-sensitive hypertension 6
- Increased risk of cardiovascular disease, as hyperuricemia is often associated with conditions such as high blood pressure, obesity, insulin resistance, and chronic kidney disease 4, 7
- Potential for renal damage, as elevated uric acid levels can cause endothelial dysfunction and renal vasoconstriction 6, 4
Lifestyle Interventions and Treatment Options
Lifestyle interventions and treatment options for hyperuricemia include:
- Lifestyle changes such as exercise, weight reduction, low consumption of purine-rich meat, and avoiding high fructose intake 3, 6
- Urate-lowering therapy (ULT) with medications such as allopurinol or febuxostat, which may help prevent or delay the decline of renal function in patients with CKD 3, 4, 5
- Consideration of xanthine oxidase inhibition in patients with high renal risk and/or declining renal function in the presence of hyperuricemia 4
Clinical Recommendations
Clinical recommendations for managing hyperuricemia include:
- Routine measurement of serum urate levels in patients with CKD and consideration of ULT initiation in those with hyperuricemia and evidence of deteriorating renal function 5
- Avoidance of antihypertensive medications that increase uric acid levels 6
- Consideration of ULT in patients with hyperuricemia and associated conditions such as hypertension, type 2 diabetes, obesity, and heart failure 4, 7