By Peter Laird, MD
KidneyTimes will feature an article on gout in the CKD population that I wrote for the Renal Support Network and Lori Hartwell called Gout and CKD - A New Era of Hope. This was a difficult article to write in many ways since the topic is quite complex even for medical professionals who deal with these issues on a regular basis, while at the same trying to give important information to those without a medical background.
Gout is unfortunately not only a bothersome and painful condition, but for those with declining renal function, the onset of gout and hyperuricemia (elevated uric acid that usually proceeds the onset of clinical gout symptoms) can actually accelerate the decline in renal function. This is especially true in the renal transplant community who must also deal with multiple drug interactions and side effects that not only promote the development of gout, but make the management with usual medications more complicated.
For all those that have chronic kidney disease at whatever stage will benefit from a better understanding of how gout can affect each of us. Fortunately, there are new medications that may make dealing with gout an easier management issue than it has been in the past, thus ushering in a new era of hope. Gout and CKD - A New Era of Hope:
The New England Journal of Medicine recently published studies on a new and more effective medicine related to Allopurinol that may change how gout is treated in the near future. Febuxostat is a potent alternative to Allopurinol even in patients with mild to moderate renal insufficiency. Febuxostat cannot be used in renal transplant patients treated with Azathioprine since it has the same interaction as Allopurinol who would then need to switch to Mycophenolate mofetil or choose another treatment option for their gout attacks. Yet for those with refractory gout episodes and hyperuricemia, the hope is that this new medicine may not only alleviate one of the most painful maladies known to mankind, but it may also help slow the progression in the decline of renal function which can be adversely affected by high urate levels.In summary, it is important to properly diagnose and manage gout to prevent long term complications which are even more prevalent in the chronic kidney disease patient and even more so in patients treated by renal transplant due to drug interactions and declining renal function throughout the life of the donated organ. Treatment options for renal transplant patients are tempered by the many drug-drug interactions with the most widely used anti-gout medications and the usual anti-rejection regimens. Recent studies give hope to chronic kidney disease patients that we can utilize a new medication called Febuxostat to prevent and treat high uric acid levels and symptomatic gout attacks. Further information of this complex subject can be found in the articles listed at the end of this article. Preventing and treating symptomatic gout is entering a new era of hope that this dreaded malady may not only be controlled but reversed.
Due to the complex nature of this subject, anyone suffering from gout and CKD will want to read this article and discuss these issues with their health care team to see if any of the newer treatments may apply to your own case. DSEN welcomes comments and questions on this article that hopefully may serve as a source of basic information on gout and how it affects the CKD population.
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