With evidence that gout highly impacts patients with advanced CKD, through increased healthcare utilization and higher cardiovascular and bone/joint comorbidity and patients with uncontrolled gout (UCG) show to have an even higher health burden and more frequent colchicine use (26%)—which has worse toxicity profile in patients with CKD—researchers sought to determine the health burden of gout in patients with CKD under the care of nephrologists. They examined chart data on random stage 3-5 patients with CKD. The criteria used to identify gout was gout listed as a comorbidity, urate-lowering therapy (ULT) use, or visible tophi/gout flare. UCG was defined as serum urate (SU) greater than 6 mg/dL with visible tophi, two or more flares in the past year, or one or more swollen/tender joints. A total of 111 physicians reported on 746 patients (55% male, aged 56.2±18.3; BMI, 31.4±10.9 kg/m2) with stage 3-5 CKD. A total of 173 patients (23%) met gout criteria, with highest frequency in stage 3b and 4 (both 28%). Of patients with gout, 13% had UCG, 29% had no formal gout diagnosis, and 38% were not using a ULT. Compared with those without gout, patients with gout more often sought acute medical care (30% vs 7% in the prior year) and, at presentation, more often had urination changes (15% vs 7%) and shortness of breath (21% vs 14%). Patients with gout had more diagnoses of CKD-mineral bone disorder, ischemic heart disease, congestive heart failure, peripheral vascular disease, and chronic pain. Compared with patients with controlled gout, those with UCG more often had pulmonary hypertension, joint issues, chronic pain, and used febuxostat and colchicine.
