What Did This Study Do
This systematic review and meta-analysis included 16 randomised controlled trials of 1,211 adults with chronic kidney disease. Most had moderate disease with a glomerular filtration rate 30 to 60ml/min/1.73m2. People were allocated to uric acid-lowering therapy or a control group who had usual treatment or a placebo.
Trials followed people for about six or 12 months one trial carried on for 84 months.
There are several limitations which reduce our confidence in the precision of the results. The cause, severity and definition of chronic kidney disease differed between studies. The trials were small, ranging from 36 to 140 participants. Only one trial was from the UK many were from China. Most were of low quality and had a short follow-up. It is nevertheless likely that the direction of effect, at least, is reasonably certain.
How Do You Treat Gout
- Eat a healthy diet.Following a healthy diet that includes whole grains, fruits, vegetables, and low-fat dairy products can decrease the frequency of gout attacks. Reduce your intake of alcohol, red meat, and high-purine foods.
- Exercise regularly. Exercise can help maintain a healthy weight. It also reduces the amount of uric acid your body produces.
- Ask about medications. If diet and exercise arent enough to reduce symptoms of gout, talk to your doctor about medications that may be available to you.
Gout And Chronic Kidney Disease
Gout and chronic kidney disease frequently coexist, as both of these diseases are affected by the high levels of uric acid in the body. Many people with CKD have uncontrolled gout that can exacerbate their condition and lead to other complications. If you are prone to gout, you are at an increased risk of developing kidney disease and vice versa.
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Consider The Source Of Uric Acid Build
Now lets turn back to the body. Uric acid is produced from birth, yet normally the body does a good job of getting rid of it as quickly as it is produced.
Gout happens when for some reason, your body stops managing to removal uric acid effectively. Doesnt it make sense then, that rather than masking the symptoms you fix what has gone wrong?
After all, were not asking your body to do anything magical. Were simply getting it back to its natural state. Is it really that complicated?
The Gout Eraser is a step-by-step system written from ancient Okinawan knowledge that the islands inhabitants have been using for centuries to re-align their bodies and getting rid of gout an ailment they consider to be easily fixed!
The Gout Eraser is the only safe way of really getting rid of gout and its the only real long-term path to remaining gout free. Check out The Gout Eraser if you havent already, to carve the path for yourself.
Why Was This Study Needed
Moderate to severe kidney disease affects 2.6 million people in England. It has a variety of causes including diabetes and inflammation. Management aims to slow progression through a variety of measures including lowering blood pressure, blood thinners, stopping smoking and dietary advice.
Uric acid is a breakdown product of blood cells and foods rich in purines. Blood levels are often high in people with impaired kidneys. It is not known whether this is a cause or consequence of chronic kidney disease.
There has been renewed interest in the relationship between uric acid levels and kidney disease with recent research showing a possible link between uric acid and the worsening of kidney disease in patients with and without diabetes. There has been conflicting evidence about whether reducing the levels of uric acid can limit the decline in kidney function or cardiovascular disease. The researchers aimed to address this through pooling the available research.
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Data Source And Study Population
This retrospective cohort study utilised data from the Clinical Practice Research Datalink . The CPRD is a large database containing anonymised UK primary care medical records . Approximately 98% of the population of England and Wales is registered with a general practitioner , who is responsible for the majority of a patients medical care . The CPRD covers more than 7% of the UK population and is representative of the general UK population in terms of age and gender distribution . More than 58% of CPRD practices are linked to hospital episode statistics . HES holds data items including admissions, diagnoses and operative procedures for all patients treated in hospitals in England . The linkage is performed by a trusted third party based on National Health Service number, date of birth and gender. As HES only covers England practices from Scotland, Wales and Northern Ireland were excluded from this analysis.
Drugs Used For Flare Prophylaxis
Although the medications used for flare prophylaxis are the same as those used to treat flares, they are generally used at lower doses and for longer periods of time . A post hoc analysis of three phase III RCTs in people starting febuxostat who also received prophylaxis with colchicine included participants with an eGFR of < 30ml/min/1.73m2 but again the results were not stratified by renal function. Long-term use of colchicine in the general population has been associated with bone marrow suppression and neuromyotoxicity, but whether these effects are increased in those with gout and CKD is unknown. Whereas short-term courses of glucocorticoids can be considered to have an acceptable riskbenefit profile, long-term use of glucocorticoids for flare prophylaxis can be associated with an increased risk of glucocorticoid-related adverse events, particularly infections, as seen in other rheumatic diseases,. This risk could be particularly concerning in a population that is already at high risk of severe infections, such as those with CKD. Whether the gout flare rate when starting ULT is the same in those with CKD as in those without, and whether prophylaxis is always required, are unknown, although a recent study of incremental use of febuxostat suggested that prophylaxis might not be required when a dose-escalation approach is used.
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How Can Gout Contribute To Kidney Disease
There is evidence that gout can lead to kidney disease, although the connection is less established. Gout happens when there is a great amount of uric acid crystallizing, resulting in joint inflammation. These crystals technically consisted of sodium urate, but they are generally referred to as uric acid crystals. Crystals often appear in the joints, but they also accumulate in the outer ear, the skin near the joints, and the kidneys.
The crystals can cause damage and scars as they pass through the kidneys. This damage to the kidneys is thought to contribute to kidney disease and failure over time, especially if the gout is left untreated. However, some people with high concentrations of uric acid levels in the blood do not develop gout and even when they do, they can go for years without manifesting any symptoms.
Uric acid can still build up in the body even with normal kidney function. If the kidneys couldnt filter uric acid effectively, uric acid can accumulate in the blood, which can lead to gout.
Confounders And Other Measured Covariates
The following variables were included in our analyses: demographic factors , socioeconomic status , comorbid conditions and lifestyle traits . An age-adjusted Charlson Comorbidity Index was used to measure disease severity.28 Data on nephrotoxic medications, NSAIDs and drugs that alter serum creatinine levels , diuretics, corticosteroids, aspirin) were also considered as potential confounders in exposureoutcomes relationship. Serum creatinine values were used to estimate kidney function through calculation of eGFR using the Chronic Kidney Disease Epidemiology Collaborative equation.2325 Data on all patient characteristics were captured during any time prior to index date and were considered for inclusion in the multivariable models for adjustment.
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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.
An Overview Of Dietary Approaches To Manage And Prevent Gout
The main principles of a gout diet are usually the same as those of any healthy, balanced diet.
- If youre overweight, reduce the number of calories you consume.
- Choose unrefined carbohydrates like fruits, vegetables, and whole grains.
- Limit your intake of sugar-sweetened beverages and foods.
- Limit your intake of organ meats .
- Cut back on saturated fats.
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Foods To Avoid With Gout
Foods to Avoid when You Have Gout.
Gout is a type of painful arthritis that can affect one or more joints, but typically occurs in the feet.
Over 8 million people in the United States have gout, making it one of the most common forms of inflammatory arthritis.
Its traditionally treated with anti-inflammatory medications and pain relievers.
Attacks are caused when uric acid crystallizes and builds up in the joints.
Uric acid, which serves as an antioxidant and protects the lining of our blood vessels.
It is created during the breakdown of an organic substance found in foods called purines.
While genetics play a role in whether or not you develop gout, lifestyle changes can help prevent pain.
Being mindful of what you eat and avoiding foods high in purines can help ward off symptoms.
How Can Kidney Disease Lead To Gout
Normal kidneys filter waste and excess fluids from the blood. However, kidney function declines when you have chronic kidney disease. The ability of the kidneys to remove excess uric acid effectively and efficiently is compromised.
Waste and minerals build up in the blood over time, worsening your kidney condition. Uric acid is a waste product found in the blood when purines are broken down in the digestive system. Most uric acid dissolves in the blood and passes through the kidneys. Uric acid leaves in the body through urine. Nevertheless, when uric acid remains in the body for too long, it can crystallize and cause gout.
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Uric acid removal agents
Drugs can also help the kidneys to excrete uric acid from the body. On one hand, these medications can be effective at reducing blood uric acid levels. On the other hand, your urinary uric acid levels are increased, contributing to painful kidney stone formation. Other side effects include stomach pains and rashes.
As you can see from the above, medications are very likely to give side effects.
The other potential issue with medications is, what happens when you stop usage? Do your blood uric acid levels go back to where they were before? Does the crystallization process in the joints continue, leading once again to red swelling and pains?
Only you can answer these questions. And if you believe the answer is yes, then its worth looking into nature-based solutions stop uric acid accumulation in your body.
Nature Based Changes
In Okinawa, an island off the coast of Japan known for being the place with the longest life expectancy, gout is treated by tackling the source of imbalance in your body. After all, your body had previously been getting rid of uric acid effectively for decades, so all we need to do is to take it back to that state.
The Gout Eraser: The all-natural guide for permanent gout removal
This is the most concise guide on restoring the body to its natural well-functioning state, by restoring the process for removing crystalline buildup in the joints, and slowing down uric acid production.
What Did It Find
- Uric acid lowering therapy reduced the risk of a kidney failure event from 29% in the control group to 12% in the therapy group .
- End-stage renal disease was reduced from 12% in the control group to 7% in the therapy group .
- Cardiovascular events such as heart attack and stroke affected 27% in the control group compared to 15% in the therapy group .
- There was no difference between the groups regarding death from any cause 4% died in the therapy group compared to 5% in the control group .
- There were low rates of side effects in the uric-acid lowering therapy group. Skin rash, muscle aches, and increased liver enzymes affected 2% of participants. There were no serious adverse effects.
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How Common Are Uric Acid Stones
It is estimated that one in 10 people in the U.S. will have a kidney stone of one kind or another at some time in their lives. In the late 1970s, about 3.8% of the population had kidney stones, but this figure has now increased to about 8.8% of the population. Among men, the lifetime risk is about 19% in women, it is 9%. Usually, the first incidence of kidney stones occurs after age 30. However, there are many cases that occur sooner, some in children as young as five years of age.
Dietary Causes Of Gout And Gouty Arthritis
Most people with gout will still need medication even if they follow a diet for gout.
Dietary changes alone can lower your uric acid levels by up to 15 percent, according to the Institute for Quality and Efficiency in Health Care , an independent scientific institute that evaluates the benefits and harms of medical interventions.
Its not necessary to avoid all high-purine foods if you have gout. Studies have shown that purine-rich vegetables dont trigger gout. And certain high-purine foods can be a good source of lean protein to incorporate into your diet.
Purine-rich vegetarian foods to include in your diet are:
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Independent Variable/outcome Of Interest
The outcome of interest was incident chronic kidney disease /kidney failure , identified by the occurrence of two diagnoses for CKD at least 4-weeks apart in Medicare claims, identified with International Classification of Diseases, ninth revision, common modification codes, 582.xx, 583.xx, 585.xx, 586.xx or 588.xx, with an absence of any CKD code in the baseline 365-day period. This ICD-9-CM code based approach has been used to assess renal disease in the validated Charlson-Romano comorbidity index , and is being currently used by the U.S. Renal Data System Coordinating Center a similar set of codes is also used in Deyo-Charlson index , another adaptation of the Charlson index. This approach is valid with high specificity of 99% and moderate sensitivity of 7088% and a median positive predictive value of 78% . These ICD-9 codes include all CKD stages of the National Kidney Foundation classification of CKD.
How Is Gout Treated
Schedule an appointment if you suspect symptoms similar to gout for proper treatment. Gout treatment is categorized into two, focusing on two different problems. The first type of treatment addresses the pain and inflammation related to gout episodes. The second treatment lowers the uric acid level in the blood. The type of medication you should take depends on the frequency and severity of your gout symptom,s as well as other health conditions you may have.
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Patients With Both Gout Chronic Kidney Disease Undertreated
We were unable to process your request. Please try again later. If you continue to have this issue please contact .Kenneth Saag
DESTIN, Fla. Patients with gout in chronic kidney disease are undertreated, and health care providers need to do more to help patients with both diseases reach serum urate targets by using existing drugs, but starting slowly, according to Kenneth Saag, MD, MSc, of the University of Alabama at Birmingham.
The big problem is that we and not us necessarily, but us physicians in general and health care providers do a really lousy job of managing people with chronic kidney disease with gout, Saag, a Healio Rheumatology Peer Perspective Board member, told attendees. We are very, very worried our colleagues in particular about these drugs in that setting, and most are just not using even the recommended dose.
Even among patients who are receiving the recommended dose of allopurinol, just under 20% are achieving serum urate levels of 6 mg/dL or less, and just under 40% achieve that target when given more than the recommended dose, he added.
These concerns were codified in 1986 with the Hande Guidelines, which were based on the understanding that the byproduct of allopurinol, oxypurinol, had prolonged retention and, in the setting of chronic kidney disease, may lead to more negative outcomes. It suggested allopurinol dosing amounts based on creatinine clearance.
Gout And Kidney Disease 17 Rapid Relief Tips To Reducing Your Gout Pain
One of the most common symptoms I see in clinic when treating clients with kidney disease, is the complaint of excruciating pain in one or many joints. They can even find it unbearable to the point that it immobilizes them, and prevents them from working. In the past this was associated with kings and royalty, due to the excess consumption of certain foods and drinks. Now it is simply known as gout and now it is very easy for all of us to over indulge. Gout and kidney disease unfortunately go hand in hand.
Gout can often seem, to begin with, a pretty innocuous condition random joint pains lasting a few hours or days at best. But soon, very soon, the gout attacks seem to be unrelenting, causing joint specific inflammation, pain, heat, and decreased movement. But dont worry I have a tool kit of natural medicines to help reverse this condition easily a little further down.
If you are currently suffering from joint pain but are unsure if it is gout or not, here is a good diagnostic checklist:
So lets go through some of these tips shall we?
Diet and Food
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