Urate-lowering therapy associated with benefit in patients with gout and CKD
The five-year risk of severe or end-stage chronic kidney disease (CKD) was lower in patients with CKD and gout who achieved a target serum urate level of less than 6 mg/dL compared to those who did not, data from the United Kingdom show.
For patients with gout and stage 3 chronic kidney disease (CKD), lowering serum urate level to less than 6 mg/dL was associated with lower risk of severe end-stage CKD, a cohort study found.
To better understand the association between achieving target serum urate level and progression of CKD, researchers analyzed nonidentified patient data from the United Kingdom between 2000 and 2023. All included patients (n=14,792) were ages 40 to 89 years and had gout and stage 3 CKD at baseline. Average participant age was 73.1 years, and 62.3% were male. Severe or end-stage CKD was defined as an estimated glomerular filtration rate of less than 30 mL/min/1.73 m2 measured on at least two occasions more than 90 days apart within one year or documentation of CKD stages 4 or 5, hemodialysis, peritoneal dialysis, or kidney transplant. Findings were published by JAMA Internal Medicine on Nov. 25.
Data showed that the five-year risk of severe or end-stage CKD was 10.32% in those who achieved the target serum urate level and 12.73% in those who did not. Compared with patients who did not achieve the target level, patients achieving the target level had an adjusted five-year risk difference and hazard ratio of severe or end-stage kidney disease of −2.41% (95% CI, −4.61% to −0.21%) and 0.89 (95% CI, 0.80 to 0.98), respectively. Among patients who initiated urate-lowering therapy, 98.8% were prescribed allopurinol and 1.2% received febuxostat; 31.8% of all patients achieved the target serum urate level within one year of the index date.
One potential biological mechanism that may account for the association between urate-lowering therapy and kidney function is that reduced serum urate levels may diminish glomerular hydrostatic pressure and subsequently mitigate kidney damage, the authors explained.
Any participant who did not have a serum urate level available before the index date was excluded from the study, potentially limiting the findings' generalizability to those who may receive less health care or experience less severe disease.
“Our findings suggest that lowering serum urate levels to less than 6 mg/dL is generally well tolerated and may even slow CKD progression in these individuals,” the researchers said, adding that initiatives to optimize the use of and adherence to urate-lowering therapy could benefit patients.