Chronic kidney disease (CKD) is a comorbid condition that affects, based on recent estimates, between 47% and 54% of patients with
gouty arthritis. However, data from randomized controlled trials in patients with
gouty arthritis and CKD are limited, and current
gouty arthritis treatment guidelines do not address the challenges associated with managing this patient population. Nonsteroidal anti-inflammatory drugs and
colchicine are recommended first-line treatments for acute
gouty arthritis attacks. However, in patients with CKD, nonsteroidal anti-inflammatory drugs are not recommended because their use can exacerbate or cause
acute kidney injury. Also,
colchicine toxicity is increased in patients with CKD, and dosage reduction is required based on level of kidney function.
Allopurinol,
febuxostat, and
pegloticase are all effective treatments for controlling elevated
uric acid levels after the treatment of an acute attack. However, in patients with CKD, required
allopurinol dosage reductions may limit efficacy;
pegloticase requires further investigation in this population, and
febuxostat has not been studied in patients with
creatinine clearance<30 mL/min. This article reviews the risks and benefits associated with currently available pharmacologic agents for the management of acute and chronic
gouty arthritis including
urate-lowering
therapy in patients with CKD. Challenges specific to primary care providers are addressed, including guidance to help them decide when to collaborate with, or refer patients to, rheumatology and nephrology specialists based on the severity of
gout and CKD.