Haemodialysis delivers urate-lowering benefit to patients with gout, ESRD

In patients with gout and end-stage renal disease (ESRD), haemodialysis appears to have an additional benefit of lowering uric acid (UA) levels, a study has found.

Researchers conducted a retrospective review of patients with gout and ESRD seen at a large urban public hospital. They identified 131 patients with ESRD on haemodialysis, 21 of whom had at least one analysis of synovial fluid demonstrating presence of monosodium urate crystals.

The 21 patients with proven gout diagnosis had a mean age of 65 years; seven of them were women, and 20 were African American. Ten (mean age 64 years, four female) out of the 21 patients had data on UA levels prior to and after haemodialysis and were included in the analysis.

The mean UA level before initiating haemodialysis was 8.43 mg/dL. This dropped to 3.98 mg/dL after treatment. Analysis revealed that the difference of −4.45 mg/dL (95 percent confidence interval, −6.49 to −2.41) in UA level prior to and after haemodialysis was clinically significant (p=0.008).

All 21 patients were receiving urate-lowering therapy prior to haemodialysis, and 11 of them discontinued their urate-lowering medication after haemodialysis.

The findings suggest that discontinuation of urate-lowering therapies may be appropriate for patients with gout and ESRD on haemodialysis. In addition, the study highlights a need for improved monitoring of UA levels and assessment of the need for urate-lowering therapy among patients with gout and ESRD on haemodialysis. This is important, as haemodialysis-treated patients often have multiple comorbidities, and urate-lowering medications contribute to polypharmacy and may induce drug interactions.