From the Guidelines
Colchicine should be avoided in patients with severe chronic kidney disease (CKD) due to the increased risk of toxicity and the lack of established safety in this population. The use of colchicine in patients with CKD requires careful consideration of the potential risks and benefits, as well as close monitoring for signs of toxicity. According to the 2016 updated EULAR evidence-based recommendations for the management of gout 1, the safe use of colchicine in patients with severe renal impairment (GFR <30 mL/min) has not been established, and it is recommended to avoid its use in these patients.
When considering the use of colchicine in patients with CKD, it is essential to take into account the potential for drug interactions, particularly with medications that inhibit CYP3A4 or P-glycoprotein, such as clarithromycin, cyclosporine, and statins 1. These interactions can increase colchicine plasma concentrations, leading to a higher risk of toxicity. In patients with mild to moderate CKD (eGFR 30-89 mL/min), the recommended dose of colchicine is 0.6 mg once or twice daily, while those with severe CKD (eGFR <30 mL/min) should receive 0.6 mg once daily or every other day.
Key considerations for the use of colchicine in patients with CKD include:
- Close monitoring for signs of toxicity, such as gastrointestinal symptoms, muscle weakness, and bone marrow suppression
- Regular monitoring of renal function and complete blood counts
- Avoidance of concomitant use with medications that inhibit CYP3A4 or P-glycoprotein
- Dose adjustment based on renal function and potential drug interactions
- Consideration of alternative treatments for gout in patients with severe CKD.
From the FDA Drug Label
8.6 Renal Impairment Colchicine is significantly excreted in urine in healthy subjects. Clearance of colchicine is decreased in patients with impaired renal function. Total body clearance of colchicine was reduced by 75% in patients with end-stage renal disease undergoing dialysis
The relationship between Colchicine and Chronic Kidney Disease (CKD) is that colchicine clearance is decreased in patients with impaired renal function, including those with CKD.
- Patients with mild to moderate renal impairment may not require dose adjustment but should be monitored closely for adverse effects.
- Patients with severe renal impairment may require dose reduction and close monitoring.
- Patients undergoing dialysis require reduced doses and close monitoring 2.
From the Research
Relationship Between Colchicine and Chronic Kidney Disease (CKD)
- The relationship between colchicine and CKD is complex, with evidence suggesting that colchicine toxicity is increased in patients with CKD 3, 4.
- Colchicine is commonly used to treat gout flares, but its use is contraindicated in severe CKD due to the risk of toxicity 5.
- However, some studies suggest that colchicine can be used safely in patients with severe CKD at reduced doses, with one study finding that colchicine was well tolerated in 77% of cases and effective in 83% of cases 5.
- The risk of colchicine toxicity in patients with CKD can be predicted by renal function, with estimates of creatinine clearance being a practical predictor of the risk of toxicity 4.
- Long-term colchicine use has been associated with a lower risk of CKD progression in some studies, particularly in patients without diabetes or hypertension, and in patients with CKD G3 6.
- The management of gouty arthritis in patients with CKD requires careful consideration of the risks and benefits of available pharmacologic agents, including colchicine, nonsteroidal anti-inflammatory drugs, and urate-lowering therapy 7.
- Colchicine dosage reduction is required based on the level of kidney function to avoid toxicity in patients with CKD 3, 7.