From the Guidelines
Urate chronic kidney disease should be managed by lowering uric acid levels through medications like allopurinol or febuxostat, and nonpharmacological interventions such as limiting alcohol and high-purine food intake, as recommended by the KDIGO 2024 clinical practice guideline 1.
Key Recommendations
- Xanthine oxidase inhibitors, such as allopurinol or febuxostat, are preferred over uricosuric agents for people with CKD and symptomatic hyperuricemia 1.
- Low-dose colchicine or intra-articular/oral glucocorticoids are recommended for symptomatic treatment of acute gout in CKD, instead of NSAIDs 1.
- Nonpharmacological interventions, such as limiting alcohol, meats, and high-fructose corn syrup intake, may help prevent gout 1.
- Regular monitoring of kidney function and uric acid levels is necessary to adjust treatment 1.
Treatment Considerations
- Adequate hydration of at least 2-3 liters of water daily is essential to prevent uric acid crystal formation.
- Dietary modifications should include reducing intake of purine-rich foods such as red meat, organ meats, seafood, and alcoholic beverages, particularly beer.
- In severe cases with significant kidney damage, dialysis may be required.
Importance of Early Intervention
- Early intervention is crucial as controlling uric acid levels can slow progression of kidney damage and prevent complications like kidney stones and gout attacks 1.
- Identifying CKD in patients with gout is of major importance because of the therapeutic implications 1.
From the Research
Urate Chronic Kidney Disease
- Uric acid levels are increased in chronic kidney disease (CKD) due to decreased glomerular filtration rate 2
- Hyperuricemia is associated with various conditions such as hypertension, type 2 diabetes, obesity, and cardiovascular disease, in addition to CKD 2
- Elevated uric acid levels have a significant role beyond causing gout, and may contribute to renal damage and cardiovascular mortality 2, 3
Urate-Lowering Therapy
- Several clinical studies suggest that urate-lowering therapy may help prevent and delay the decline of renal function in patients with CKD 2, 4
- Xanthine oxidase inhibitors, such as allopurinol and febuxostat, are commonly used for urate-lowering therapy in CKD patients 2, 4, 5, 6
- Febuxostat may be more effective than allopurinol in lowering uric acid levels and controlling blood pressure 5, 6
Renal Outcomes
- Network meta-analysis of randomized controlled trials found no significant difference in renoprotective effects between febuxostat, allopurinol, and benzbromarone in CKD patients with hyperuricemia 5
- A propensity score-matched cohort study found that febuxostat was associated with greater reduction in serum uric acid levels than allopurinol, but no difference in renal function changes 6
- Further investigation is needed to determine the long-term effects of urate-lowering therapy on renal outcomes in CKD patients with hyperuricemia 5, 6