Serum urate may be safely lowered in gout patients with impaired kidney function

Achieving target serum urate levels with urate-lowering therapy (ULT) does not appear to worsen kidney function in patients with gout and chronic kidney disease (CKD), as shown in a study.

Researchers conducted a target trial emulation approach using data from a general practice database. A total of 14,792 patients (mean age 73.1 years, 62.3 percent men) with gout and with CKD stage 3 were included in the analysis.

The main outcome of progression to severe or end-stage kidney disease was evaluated in relation to lowering serum urate level to <6 mg/dL with ULT. Severe or end-stage kidney disease was defined by an eGFR of <30 mL/min/1.73 m2 on at least two occasions (more than 90 days apart) within 1 year or at least one Read code (per the Refined Etiology, Anatomical Site, and Diagnosis classification) for CKD stages 4 or 5, haemodialysis, peritoneal dialysis, or kidney transplant.

The 5-year risk of severe or end-stage kidney disease was 10.32 percent for patients who achieved the target serum urate level as opposed to 12.73 percent for those who did not. The corresponding adjusted 5-year risk difference was –2.41 percent (95 percent confidence interval [CI], −4.61 to −0.21).

Logistic regression analysis showed that the hazard ratio for progression to severe or end-stage kidney disease among patients who did vs did not meet target serum urate levels was 0.89 (95 percent CI, 0.80–0.98), respectively.

The findings provide evidence to support optimization of ULT to meet target serum urate levels in gout patients with compromised kidney function.