From the Guidelines
A uric acid level of 6.2 mg/dL is slightly elevated and requires monitoring, but immediate medication is not necessary unless symptoms of gout or kidney stones are present. According to the 2016 updated EULAR evidence-based recommendations for the management of gout 1, the target serum urate (SUA) level should be maintained at <6 mg/dL (360mmol/L) for most patients. Since the given uric acid level is 6.2 mg/dL, which is slightly above the recommended target, lifestyle modifications are recommended to prevent further increases. These modifications include reducing intake of purine-rich foods, limiting alcohol consumption, maintaining adequate hydration, achieving a healthy weight, and regular exercise. The American College of Physicians also suggests that gout-specific counseling about dietary changes may not be more effective than general dietary counseling for reducing serum urate levels in patients with gout 1. However, if symptoms of gout or a history of kidney stones are present, consultation with a healthcare provider is necessary to consider medication like allopurinol. Regular monitoring every 6-12 months is advisable to track any changes in uric acid levels. Key points to consider:
- Lifestyle modifications to reduce uric acid levels
- Monitoring of uric acid levels every 6-12 months
- Consideration of medication if symptoms of gout or kidney stones are present
- Target serum urate level should be maintained at <6 mg/dL (360mmol/L) for most patients.
From the FDA Drug Label
It is an inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine and of xanthine to uric acid, the end product of purine metabolism in man. The etiology of this hyperuricemia is the overproduction of uric acid in relation to the patient's ability to excrete it If progressive deposition of urates is to be arrested or reversed, it is necessary to reduce the serum uric acid level below the saturation point to suppress urate precipitation. Administration of allopurinol tablets generally results in a fall in both serum and urinary uric acid within 2 to 3 days.
A uric acid level of 6.2 is considered elevated.
- The patient may have hyperuricemia, which can be primary or secondary to other diseases.
- Allopurinol can be used to treat hyperuricemia by reducing serum uric acid levels.
- The goal of treatment is to reduce the serum uric acid level below the saturation point to prevent urate precipitation.
- The degree of decrease in serum uric acid level can be manipulated with allopurinol dosage 2.
From the Research
Uric Acid Levels and Chronic Kidney Disease
- A serum uric acid level of 6.2 mg/dL is considered elevated, as seen in a study where the serum uric acid levels significantly increased from 6.2 ± 1.1 to 6.6 ± 1.1 mg/dl in the allopurinol group 3.
- Elevated uric acid levels are associated with an increased risk of developing chronic kidney disease (CKD) and hypertension, with a study showing that higher uric acid levels had a closer association with the new development of CKD and hypertension 4.
- In patients with CKD, reducing serum uric acid levels may help slow the progression of renal disease, as demonstrated by a study where febuxostat reduced serum uric acid levels and slowed the progression of renal disease in a CKD cohort compared to allopurinol 3.
Treatment Options for Hyperuricemia
- Febuxostat is a novel xanthine oxidase inhibitor that can effectively reduce serum uric acid levels in patients with CKD, with a study showing that febuxostat decreased serum uric acid concentrations from 8.4 (±1.4) mg/dL to 6.2 (±1.2) mg/dL at 6 months 5.
- Probenecid can be used in combination with febuxostat to achieve target uric acid levels, as illustrated by a case report where a patient with refractory hyperuricemia achieved a reduction in uric acid level to less than 6 mg/dL following addition of probenecid to febuxostat regimen 6.
Relationship Between Uric Acid Levels and CKD Outcomes
- Hyperuricemia is associated with all-cause mortality and cardiovascular disease mortality in CKD patients, but not with the development of end-stage renal disease (ESRD) or a 50% reduction in estimated glomerular filtration rate (eGFR) 7.
- Reducing serum uric acid levels may help improve renal function in patients with CKD, as demonstrated by a study where febuxostat treatment resulted in a significant increase in eGFR at 6 months 5.