Managing Hyperuricemia and Gout in Chronic Kidney Disease

A Clinical Conundrum

Kulanka H. Premachandra; Richard O. Day; Darren M. Roberts

Disclosures

Curr Opin Nephrol Hypertens. 2021;30(2):245-251. 

In This Article

Treatment of Acute Gout

Colchicine, NSAIDs and prednisolone are used to treat gout flares, refer to Table 2 for guidance. The American College of Rheumatology (ACR), EULAR and British Society of Rheumatology guidelines do not prioritize between these first-line agents on the basis of clinical efficacy.

However, drug selection varies depending on patient factors including comorbidities such as CKD, hypertension, peptic ulcer and diabetes, ease of access, familiarity and past experience. IL-1 inhibitors, such as anakinra and canakinumab are recommended only in circumstances where other anti-inflammatory therapies are either ineffective, poorly tolerated or contraindicated. A recent randomized controlled trial comparing anakinra to either colchicine, naproxen or prednisolone found anakinra to be noninferior to the comparator first-line therapies for acute gout in patients with creatinine clearance more than 30 ml/min.[23] However, anakinra's use is affected by high cost, lack of universal access to the drug globally and limited data of its safety in CKD.

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