Urate levels and clearance in renal patients under peritoneal dialysis

Diez-Lopez, Claudia; Pérez-Contreras, Javier; Andrés, Mariano

doi:10.1080/15257770.2021.1934482

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…While no differences were seen when comparing automatic and manual forms of PD, there was a difference between the automated techniques showing that continuous cyclic PD was more effective at lowering SU levels than nocturnal intermittent PD. 62 However, PD patients who are also prescribed diuretics and angiotensin-converting enzyme inhibitors to help with volume status and peritoneal membrane function may experience more episodes of gout because these drugs can cause hyperuricemia. 58 We personally favor the continuation of ULT, in lower doses, if patients with ESKD on RRT are still having gout flares or if they have not achieved a SU level of <6 mg/dl.…”

Section: Dialysismentioning

confidence: 99%

“…Another study analyzed the effects of PD on SU levels and showed that most patients undergoing PD have a normal SU level. 62 This study included 20 patients, and only two patients remained hyperuricemic after a median of 20 months of PD. While patients on ULT in this study did have a statistically significantly lower mean urate level (4.2 mg/dl) when compared with patients who were not on ULT (5.6 mg/dl), both groups remained below the threshold of hyperuricemia.…”

Section: Dialysismentioning

confidence: 99%

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Management of Patients with Gout and Kidney Disease: A Review of Available Therapies and Common Missteps

Kannuthurai

Gaffo

2023

Kidney360

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Gout, a common form of inflammatory arthritis, is characterized by deposition of monosodium urate crystals in articular and periarticular tissues. Repeated flares of gout cause joint damage as well as significant healthcare utilization and decreased quality of life. Individuals with chronic kidney disease (CKD) have a higher prevalence of gout. Treating individuals with CKD and gout is challenging due to the lack of quality data to guide management in this specific population. This often leads to suboptimal treatment of patients with gout and impaired renal function, as concerns regarding the efficacy and safety of available gout therapies in this population often result in significant inter-physician variability in treatment regimens and dosages. Acute gout flares are treated with various agents, including nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, and – more recently – interleukin-1 inhibitors. These medications can also be used as prophylaxis if urate lowering therapy (ULT) is initiated. While these drugs can be used in patients with gout and CKD, there are often factors that complicate treatment such as the numerous medication interactions involving colchicine as well as the impact of glucocorticoids on common comorbidities like diabetes and hypertension. ULT is recommended to treat recurrent flares, tophaceous deposits, and in those with moderate-to-severe CKD with a serum urate goal < 6 mg/dL recommended to prevent flares. While many misconceptions exist around the risks of using urate-lowering agents in patients with CKD, there is some evidence that these medications can be used safely in individuals with renal impairment. Additional questions exist as to whether gout treatment is indicated for individuals on renal replacement therapy. Furthermore, there is conflicting data on whether ULT can impact renal function and cardiovascular disease in patients. All of these factors contribute to the unique challenges physicians face when treating patients with gout and CKD.

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Section: Dialysismentioning

confidence: 99%

Section: Dialysismentioning

confidence: 99%

Management of Patients with Gout and Kidney Disease: A Review of Available Therapies and Common Missteps

Kannuthurai

Gaffo

2023

Kidney360

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“…Hemodialysis (HD) easily clears uric acid, a small non-protein bound molecule. Peritoneal dialysis (PD), particularly continuous cycling PD, also effectively reduces SUA concentrations [8]. Despite the rationale that KRT lowers SUA concentration through dialysis clearance and therefore reduces clinical significance of gout among patients with kidney failure (KF) on dialysis, an observational study suggested an increased risk of all-cause mortality among end-stage kidney disease (ESKD) patients with incident gout episodes [9].…”

Section: Introductionmentioning

confidence: 99%

“…Peritoneal dialysis (PD), particularly continuous cycling PD, also effectively reduces SUA concentrations. 8 Despite the rationale that KRT lowers SUA concentration through dialysis clearance and therefore reduces clinical significance of gout among patients with KF on dialysis, an observational study suggested an increased risk of all-cause mortality among ESKD patients with incident gout episodes. 9 Notably, the cumulative incidence of gout in the dialysis population can be as high as the general population, suggesting that KRT may not reduce gout risk among patients with advanced CKD.…”

Section: Introductionmentioning

confidence: 99%

Gout Prevalence, Practice Patterns, and Associations with Outcomes in North American Dialysis Patients

Guedes¹,

Zhao²,

LaMoreaux³

et al. 2022

Kidney360

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Background: Gout occurs frequently in patients with kidney disease and can lead to a significant burden on quality of life. Gout prevalence, and its association with outcomes in hemodialysis (HD) and peritoneal dialysis (PD) populations located in North America, is unknown. Methods: We used data from North America cohorts of 70,297 HD patients (DOPPS, 2012-2020) and 5,117 PD patients (PDOPPS, 2014-2020). We used three definitions of gout for this analysis: (1) having an active prescription for colchicine or febuxostat; (2) having an active prescription for colchicine, febuxostat, or allopurinol, or (3) having an active prescription for colchicine, febuxostat, or allopurinol, or prior diagnosis of gout. Propensity score matching was used to compare outcomes among patients with vs. without gout. Outcomes included erythropoietin resistance index (ERI = ESA dose/(hemoglobin*weight)), all-cause mortality, hospitalization, and patient-reported outcomes (PROs). Results: Gout prevalence was 13% in HD and 21% in PD; it was highest among incident dialysis patients. Description of previous history of gout was rare, and identification of gout defined by colchicine (2-3%) or febuxostat (1%) prescription was less frequent than by allopurinol (9-12%). Both HD and PD patients with gout (vs. no gout) were older, more likely male, with higher BMI, and higher prevalence of cardiovascular comorbidities. About half of patients with a gout history were prescribed urate lowering therapy. After propensity score matching, mean ERI was 3-6% higher for gout vs. non-gout patients, while there was minimal evidence of association with clinical outcomes or PROs. Conclusion: In a large cohort of PD and HD patients in North America, we found that gout occurs frequently and is likely underreported. Gout was not associated with adverse clinical or patient-reported outcomes.

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Urate levels and clearance in renal patients under peritoneal dialysis

Cited by 2 publications

References 25 publications

Management of Patients with Gout and Kidney Disease: A Review of Available Therapies and Common Missteps

Management of Patients with Gout and Kidney Disease: A Review of Available Therapies and Common Missteps

Gout Prevalence, Practice Patterns, and Associations with Outcomes in North American Dialysis Patients

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