The Role of a “Treat-to-Target” Approach in the Long-Term Renal Outcomes of Patients with Gout

Abstract

Background: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a “treat-to-target” approach in relation to renal outcomes. Methods: Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). Results: Improvement in renal function was only demonstrated in subjects in whom the serum urate target of <6 mg/dL was achieved (76.40 ± 18.81 mL/min/1.73 m2 vs. 80.30 ± 20.41 mL/min/1.73 m2, p < 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (−0.35 ± 3.87 mL/min/1.73 m2 vs. 5.33 ± 11.64 mL/min/1.73 m2, p = 0.019). Multivariable analysis predicted that patients ≥65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13–0.75, p = 0.009). Conclusions: The “treat-to-target” approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.

A glance into the future of gout

“… 141 , 142 Allopurinol (dosed to achieve target urate levels and not limited by creatinine clearance-based formulae) and febuxostat are effective and safe in people with gout and CKD, 143 , 144 and recent data suggest that lowering urate levels to achieve crystal dissolution may prevent renal function decline in people with gout. 145 , 146 However, the combination of gout and renal disease is full of uncertainties in multiple areas (pathophysiology, prognosis, management, among others) and merits focussed research. 140 …”