Managing Gout in Patients With Moderate to Advanced CKD

Patients with chronic kidney disease commonly experience gout, a clinical manifestation of inflammation in joints and soft tissue induced by hyperuricemia. Gout in patients with CKD may exacerbate declines in kidney function. Few data are available on monitoring of gout episodes and treatment practices among the CKD population, despite a growing burden globally.

During a poster session at ASN Kidney Week 2024, Deepika Laddu, PhD, and colleagues presented results of a multi-country study examining the prevalence, patient characteristics, and medical management of patients with gout and nondialysis-dependent moderate to advanced CKD. The poster was titled Gout Prevalence and Management Strategies Among Patients With Moderate to Advanced CKD.

The researchers analyzed cross-sectional data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDOPPS) on 942 enrolled patients in Brazil and 2,582 enrolled patients in the United States (total, 3,524). Eligible patients had nondialysis-dependent CKD stage 3b-5. Study coordinators extracted data on the history of gout (yes/no) from medical records. Patient characteristics, gout treatment, and uric acid measurement practices were summarized based on gout diagnosis and country.

Overall, the prevalence of gout was 19%. In the United States, the prevalence was 21%; in Brazil, the prevalence was 14%. In both countries, gout prevalence was higher in patients with CKD stage 4-5 compared to those with CKD stage 3b. Compared to patients without gout, those with gout were more likely to be male (66% vs 49%). Despite similar levels of body mass index across the groups, patients with gout had a higher prevalence of cardiovascular comorbidities.

In the group with gout, the most utilized gout treatment was allopurinol in both the United States and Brazil (62% and 75%, respectively). In the United States, colchicine and febuxostat were also used (13% and 8%, respectively); both were rarely used in Brazil (<5%).

In the United States, mean uric acid among the patients with gout was 7.0 mg/dL in Brazil and 6.7 mg/dL in the United States. Only 30% of patients with gout in the United States had a uric acid measurement compared to 70% in Brazil.

In conclusion, the researchers said, “Gout affects a substantial proportion of the nondialysis CKD population, with differing management and monitoring strategies between the United States and Brazil. Further examination of the effectiveness of gout diagnosis and treatment practices between countries may provide an important opportunity to improve patient outcomes.”

Source: Laddu D, Sylvertooth D, Guedes MH, et al. Gout prevalence and management strategies among patients with moderate to advanced CKD. FR-PO1117. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2024; October 25, 2024; San Diego, California.