Gout Common In Advanced Kidney Disease And Dialysis
Findings from separate studies presented at the National Kidney Foundations 2022 Spring Clinical Meetings zero in on the prevalence, clinical features, risk factors, and outcomes of gout in patients with advanced kidney disease , including those receiving dialysis.
In a study of 231,841 Medicare patients on dialysis identified using the US Renal Data System database, Anthony J. Bleyer, MD, of Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues found a 13.5% prevalence of gout. In adjusted analyses, patients with gout had a significant 6% increased risk for a composite of death and hospitalization due to cardiovascular causes compared with non-gout patients, Dr Bleyers team reported in a poster presentation.
In addition, patients with vs without gout also had significant 34% and 18% increased odds of blood transfusion and higher erythropoiesis-stimulating agent dose, respectively, after adjusting for patient demographics, dialysis characteristics, and comorbid condition, the investigators reported. The patients with gout also had higher ferritin levels and lower transferrin saturation compared with non-gout patients.
The other study revealed an overall gout prevalence of 23.2% in a cohort of 746 patients with advanced CKD seen by 111 nephrologists. The cohort included 61 solid organ transplant recipients and 83 with end-stage kidney disease.
How Can You Prevent Gout If You Have Kidney Disease
- Follow a healthy kidney-friendly diet. Reducing your sodium and protein intake can help you feel your best while maintaining a healthy weight. However, this doesnt mean you need to give up all the foods and drinks you love. Check out these kidney-friendly recipes for inspiration.
- Take your medications as prescribed. Certain medications used to treat gout are not safe for your kidneys. Make sure to talk to your doctor about what medications to take and how frequently.
- Monitor your weight. Obesity is a risk factor for gout. When coupled with kidney disease, it may increase your chances of having gout. Work with your care team to develop a plan for reaching and maintaining a healthy weight. Your care team can also help you monitor your weight and keep track of any changes.
- Maintain a healthy blood pressure. Lowering your blood pressure is important for protecting your kidneys and overall health. Your doctor can help you create a treatment plan to take control of your blood pressure.
- Maintain a healthy blood sugar level. Frequent or ongoing high blood sugar can cause damage to your nerves, blood vessels, and kidneys. To help reduce the risk of an attack of gout, it is important to keep your blood sugar levels balanced.
Uric Acid As A Marker Of Kidney Disease: Review Of The Current Literature
1Department of Internal Medicine, University of Central Florida, College of Medicine, Orlando, FL 32827, USA
2Orlando VA Medical Center, Orlando, FL 32827, USA
Uric acid has been implicated in the pathophysiology of renal disease however renal clearance makes a causal relationship difficult to prove. We examine the current literature to support a potential role of uric acid in the development of kidney disease and to determine the potential to use uric acid as a marker for future renal decline. After review, we conclude that uric acid is definitively linked to the development of chronic kidney disease and can be a poor prognostic factor for the development of acute renal failure, as well. However, further human research is needed before predictive models utilizing uric acid can be developed and used in the clinical setting.
2. Pathophysiology of Uric Acid in Development and Progression of Renal Disease
3. Hyperuricemia and Risk of Development of Renal Disease
Finally, Weiner et al. performed a prospective cohort study following over 13,000 people with normal kidney function and found that 7.9% of the cohort developed renal disease by follow-up at 8.5 years. Logistic regression models determined that a baseline elevated serum uric acid level predicted worsening renal function irrespective of age, gender, race, diabetes, hypertension, alcohol use, smoking, lipids, and baseline renal function .
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The Pain Of Kidney Stones
One of the most common ailments associated with gout and the kidneys is kidney stones. The presence of too much uric acid in the body is the primary source of kidney stones in people who suffer with gout. A person who suffers with multiple attacks of gout is at much higher risk for developing kidney stones than the average person. Depending upon the type of gout an individual has will effect the probability of occurrence. People with primary gout have 10-25% more kidney stones than the average population and nearly 42% of secondary gout sufferers develop kidney stones.
Control Gout And Protect Your Kidneys
Maintaining a healthy serum uric acid level of 6.0 mg/dL or below is important to reduce the risk for gout and kidney disease. Ask your doctor for a routine serum uric acid blood test to see if you have elevated uric acid. The doctor can also run tests to measure your kidney function.
If your uric acid levels are high, your doctor may prescribe medications to keep uric acid levels low and reduce your risk for future gout flares. It is important to take these medications as prescribed and not to stop them without talking with the doctor. It is also important to tell your doctor about all other medications and supplements you are taking, as some may be raising your uric acid levels.
Other steps such as drinking plenty of water to flush the kidneys and help to remove uric acid from the bloodstream exercising and maintaining a healthy body weight and avoiding trigger foods are also important for reducing risk.
To learn more about gout and kidney health, this brochure. Additional information about kidney health is available through the National Kidney Foundation at Kidney.org/atoz.
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Is My Diet Responsible For My Gout
Gout is mainly caused by your body not getting rid of uric acid properly. This could be because of your genes, your weight or kidney problems. Diet has a much smaller role in causing your gout . But if you notice certain foods or drinks trigger your gout attacks, you may benefit from cutting down the amounts of these in your diet.
Follow these dos and donts to help reduce gout attacks:
|If you are overweight, get to a healthy weight. Exercise regularly, except during a gout attack. Keep eating a healthy diet. Eat lots of vegetables and some fruit. Eat at least 2 servings of low-fat dairy products every day. Keep yourself hydrated by drinking plenty of water.||Try crash diets that cause rapid weight loss. Dont drink too much beer, RTDs or other alcohol. Dont drink sugary drinks such as energy drinks, ordinary soft drinks, orange juice or powdered drinks. Eat full-fat dairy products.|
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Role Of Combination Ult
Combination therapy with a XOI and a uricosuric can be very effective, and if uricosuric toxicity is a consequence of urate concentration within renal tubules then combination therapy could theoretically ameliorate such toxicity. However, as uricosuric treatment is usually not considered for patients with advanced CKD this approach is largely untested.
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How Gout Can Affect Your Kidneys
Living with gout can be challenging, painful and unpredictable, especially if lifestyle changes havent brought your uric acid levels down to normal. If infrequent gout attacks become more regular, you may develop chronic gout, and that can stress other systems in your body, particularly your renal system.
The kidneys are at the center of your renal system, and they manage the outflow of waste products. Uric acid is one of these natural waste products, and when it builds up it can form sharp uric acid crystals the main culprits in gout attacks. Since the kidneys are responsible for filtering out uric acid, its no surprise that gout and kidney health are closely related.
When you live with gout, your kidney health largely depends on how well you manage your condition, but simply keeping your blood uric acid level down may not be enough to prevent kidney trouble. Learn how gout, uric acid and kidney function are related in order to protect against painful and damaging complications.
How To Manage Gout Attacks
- Medically reviewed by
Gout attacks, also called flares or flare-ups, can come on suddenly and be extremely painful. During a gout attack you may have pain, swelling, and/or redness in your affected joint.Gout attacks can last anywhere from a few hours to several days. When you have acute gout, you may only have attacks once or twice a year. When you have chronic gout, attacks happen more regularly, with shorter breaks in between attacks.There are things you can do to manage your symptoms during gout attacks. The main goal of treatment during an attack is to decrease joint pain and swelling. If you already take a medicine to lower uric acid at the time of an attack, you should continue your regular treatment. If you do not already take a medicine to lower uric acid at the time of an attack, you should not start treatment during an attack, but rather start treatment afterwards, on your doctor’s advice.Some ways to manage gout pain and swelling during an attack are:
If the pain during a gout attack does not get better at all within 48 hours, call your doctor to ask about other treatments you can try.Treatments are also available to prevent gout attacks from happening in the first place. Having gout attacks more often can increase your chances of having even more attacks in the future, so controlling the condition from the start is important. Talk to your doctor about whether medicines to prevent gout attacks are right for you.
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When Should I Call My Doctor
- You have a fever, chills, or body aches.
- You are confused or more tired than usual.
- You have new symptoms, such as a rash, after you start gout treatment.
- Your joint pain and swelling do not go away, even after treatment.
- You are not urinating as much or as often as you usually do.
- You have trouble taking your gout medicines.
The Link Between Gout And Kidney Disease
When your kidneys do not work the way that they should, it can lead to gout. Its important to treat and prevent future attacks of gout as it can lead to permanent joint and bone damage. Since kidney disease and gout are closely related, protecting your kidney function is one way to reduce symptoms of gout.
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Kidney Disease And Gout
People who have kidney disease are generally more susceptible to abnormally high amounts of uric acid in their blood, or hyperuricemia. Because their kidneys are unable to remove adequate amounts of uric acid from the body, gout occurs. If a person has had a kidney transplant, they become more susceptible to gout as a result of medications taken to aid the assimilation of the kidney into the body. These medications tend to increase the amount of uric acid in the individual’s body and the person may develop gout, tophi and persistent arthritis as a result of medication.
Management Of Gout In Ckd
The management of gout follows the same four principles regardless of the presence of CKD: 1) lower SUA 2) provide prophylaxis while initiating ULT 3) treat gout flares and 4) optimize dietary and lifestyle factors as appropriate. Over a prolonged period of time with adequate management of hyperuricemia, defined as maintenance of a SUA level < 6 mg/dL or < 5 mg/dL for those with tophaceous gout, gout flares will diminish in frequency and severity, with eventual cessation of flares, and tophi can be prevented and/or resolve.
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Myth: If You Stay Away From Liver And Alcohol Youll Avoid Gout Attacks
Truth: Alcoholic drinks especially beer and organ meats such as liver and some fish, including anchovies and sardines, are very high in a class of natural substances known as purines. When the body breaks down purines it creates uric acid, so eating a lot of purine-rich foods does increase the risk of an attack. But while avoiding these foods may reduce attacks, it wont halt them, says Reveille.
Gout can be life threatening if left untreated.
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Level Of Renal Function Precluding Ult
Because most large RCTs have excluded people with substantial renal impairment, there are few data from RCTs to inform decisions about when specific ULTs should not be used on the basis of kidney function. No studies have specifically examined the risks and benefits of not treating gout in people with CKD with ULT, and all current guidelines recommend ULT treatment in this population. In many patients, but not all, untreated gout causes considerable morbidity in its own right, and in those with CKD the only option for treating flares might be long-term corticosteroids, which is associated with further morbidity.
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How Can Losing Weight Help My Gout
Being overweight can increase your risk of gout because carrying extra weight slows down the removal of uric acid by your kidneys. Gout is caused by high uric acid levels in your blood as your level of uric acid rises, your risk of gout increases. If you are overweight, gradual weight loss can help to lower your uric acid levels and reduce your risk of gout attacks.
Weight loss is best achieved by eating a balanced diet and regular physical activity.
- Avoid fasting or crash diets, where you go without adequate food for long periods and lose weight rapidly. This type of dieting can increase uric acid levels and trigger a gout attack.
- Examples of foods to include in your diet are low-fat dairy, soy-based foods, vegetable sources of protein and foods high in vitamin C.
- Exercise moderately, but during an acute attack rest, elevate and cool affected joints.
Living With Gout And Kidney Disease
Treatments can be difficult when youhave kidney disease and gout. For instance, NSAIDs used in gout treatmentcanbe harmful to kidneys. Also, medicines used for treating kidney disease likediuretics and beta-blockers can contribute to the development of gout. So, ifyou have both these diseases, it is important for you to communicate with yourdoctor about all the medicines that you take.
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Foods And Drinks To Avoid When You Have Gout
Alcohol is a trigger for gout attacks. When you drink, your kidneys work to filter out alcohol instead of uric acid, leaving uric acid to build up in your body. Beer is especially bad for gout because it has purines.
Sugary drinks , sugary foods, and foods with high-fructose corn syrup should be limited because of their connection to gout. There is less evidence about why these foods and drinks increase the risk of gout, but some connection has been found.Foods that are high in purines should be completely avoided since they contribute to creating uric acid in your body. These include:
Content courtesy of the National Institutes of Health .
What Are The Symptoms Of Gout
- Severe joint pain. Although gout can affect any joint, it commonly occurs in the big toe, ankles, knees, elbows, wrists, and fingers.
- Inflammation and redness. When the crystals settle in a joint, that joint becomes red, swollen, and tender.
- Limited range of motion. As the crystals form around your joints, you may not be able to move your joints properly, or they may feel stiff.
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Myth: There Arent Effective Medicines For Gout
Truth: Many medications put the brakes on gout. Some control pain and inflammation immediately and others get at the root cause by eliminating the deposited uric acid crystals.
Colchicine is prescribed for acute gout flare-ups. A plant extract, its been used to treat gout for 2,000 years, says Reveille. Colchicine works within several minutes to several hours to block gout inflammation. The sooner you start it, the more likely the attack will resolve quickly. An injected steroid also tackles inflammation, usually controlling pain and swelling within 24 hours.
Prescription drugs such as allopurinol , febuxostat and probenecid all alleviate gout by controlling blood levels of uric acid. Also, two years ago the FDA approved an intravenous drug for people with advanced gout pegloticase that lowers uric acid levels and reduces deposits of uric acid crystals in the joints and soft tissue.
Most people who have gout will need to be on a uric-acid-lowering drug for life, usually just one or two pills a day, says George Washington Universitys Baraf.
Changing your diet can help reduce the frequency of gout attacks.
Can Repeated Gout Attacks Cause Permanent Damage To The Joints
ByHeemen Ee | Submitted On May 13, 2010
Yes! It will and the damage is permanent and irreversible! Thus, you must take actions to prevent the condition from getting worse before it is too late.
Gout attack is an autoimmune reaction that is triggered by the urate crystals that form within the synovial fluid inside the joints. Formation of these tiny needle-like crystals can happen over night without any pre-warning or signs.
The sudden occurrence of these solid objects was treated as foreign invaders by the immune system and it will send signals through hormones and enzymes to activate a series of defensive mechanisms. The same reaction that happens when the saliva of mosquito that bites you goes into your body, but in the case of gout, it happens deep inside the joint.
The inflammation or swelling will last for days with or without medications. Most people think that gout is gone after the pain is gone. No way! The immune reaction will subside over time but that does not mean that the urate crystals have been removed.
This is because urate crystal is not anything organic. It is not virus, not bacteria, not fungus that can be destroyed with antibiotic or consumed by phagocytes . After all, gout is not caused by any microbes. It is a disease that resulted from ones diet or lifestyle.
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