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. 2022 Jul;25(7):769-774.
doi: 10.1111/1756-185X.14334. Epub 2022 May 16.

Urate-lowering therapy for patients with gout on hemodialysis

Reem Alkilany  1 , Douglas Einstadter  2 , Maria Antonelli  1
Affiliations

Urate-lowering therapy for patients with gout on hemodialysis

Reem Alkilany et al. Int J Rheum Dis. 2022 Jul.

Abstract

Objective: Gout is the most common form of inflammatory arthritis and is caused by deposition of monosodium urate crystals resulting from a high burden of uric acid (UA). High UA burden also has been associated with increased morbidity and mortality in the general population and progression to chronic kidney disease. In persons with gout and end-stage renal disease (ESRD), prior studies suggest that UA levels decrease after initiation of hemodialysis (HD). We evaluated UA level and the use of urate-lowering therapies (ULTs) in patients with gout and ESRD on HD.

Methods: We performed a retrospective review of patients with gout and ESRD seen at a large urban public hospital (The MetroHealth System). We extracted data from the medical record (Epic) for patients diagnosed with gout and ESRD on HD. The main outcomes were the UA level and the use of ULTs before and after HD initiation.

Results: We identified 131 patients with gout on HD. Of these, 21 patients had crystal proven gout diagnosis, 10 of whom had data on UA level pre-HD and post-HD and were included in the analysis. For the total sample (N = 21), the mean age was 65 years, 7 were female and 20 were African American. Mean pre-HD and post-HD UA levels were 8.4 and 3.98 mg/dL respectively. Twenty-one patients were receiving ULT pre-HD, 11 discontinued post-HD.

Conclusion: Among patients with gout and ESRD, we observed a decrease in UA level associated with initiation of HD. For this group, discontinuation of ULTs may be appropriate.

Keywords: end-stage renal disease on hemodialysis; gout arthritis; urate-lowering therapy.

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Conflict of interest statement

No conflict of interest.

Figures

FIGURE 1
FIGURE 1
Consolidated Standards of Reporting Trials flow diagram. CPPD, calcium pyrophosphate crystals; HD, hemodialysis; MSU, monosodium urate crystals; SUA, serum uric acid
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