Urate Lowering Therapy Limits Gout Flares During Hemodialysis

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Urate lowering therapy (ULT) was found to limit new gout flares occurrence in patients on hemodialysis with a history of gout.¹

“In conclusion, when considering gout patients starting hemodialysis, urate lowering therapy limited the occurrence of new gout flares compared to patients not treated. To our knowledge, this is the first study analyzing long term effect of ULT in hemodialysis patients on gout flares,” lead investigator Alexia Steelandt, Rheumatology Department, University Hospital of Reim, and colleagues wrote.¹

Steelandt and colleagues performed a retrospective cohort study of adult participants from hemodialysis centers in France, with a history of gout and who had started hemodialysis between January 2005 and September 2015. They analyzed clinical data, including demographics and clinicals, from hemodialysis start and through 5 years of follow up. Gout flare was defined as presence of uric acid crystal in joint junction or was clinically diagnosed as such with a colchicine prescription.

The investigators included a total of 181 participants in their analysis, for whom the mean age at dialysis initiation was 68.6 years (standard deviation, 12.4). Most (72%) were men, 54% were receiving ULT, 89.7% were receiving allopurinal and 9.3% were receiving febuxostat (1 patient received both treatments successively). Around a third (35.36%) of participants experienced at least 1 gout flare during hemodialysis. In the ULT group, the incidence of 1 gout flare was 22.68% compared with 50% in the no ULT group (P = .0002).Accordingly, the ULT group (median, 53%) had a significantly higher proportion of patients with serum urate values within the target than the no ULT group (median, 29.3%; P <.0001).

The investigators also measured dialysis efficiency at regular intervals during follow-up and found that it was similar between groups. They used a Cox model to analyze the association strength between ULT use and the occurrence of gout flares and found that ULT is a protective factor for gout flare (hazard ratio, 0.42 [95% CI, 0.25-0.71]).²

“Results from this analysis may have implications in managing dialysis patients with history of gout. Further research on this topic and collaboration between rheumatologists and nephrologists may help to inform updated guidelines specifically for urate-lowering therapy in patients on dialysis,” Steelandt and colleagues concluded.¹

Other recent research on hospitalizations and gout found associations between a number of metabolites and the risk of incident hospitalized gout. After correcting for multiple testing, 107 metabolites were associated with the incidence of hospitalized gout (N=2735) before urate adjustment. These included glycine (HR, 0.64 [95% CI, 0.54-0.75]; P = 8.3x10-8) and glutamine (HR, 0.69 [95% CI, 0.61-0.78]; P = 3.3x10-9) inversely, between extreme quintiles, and glycoprotein acetyls (GlycA; HR, 2.48 [95% CI, 2.15-2.87]; P = 1.96x10-34). After adjusting for urates, the associations remained significant and directionally consistent, with respective HRs of 0.83 (95% CI, 0.70-0.98), 0.86 (95% CI, 0.76-0.98), and 1.41 (95% CI, 1.21-1.63) between extreme quintiles, with corresponding HRs per standard deviations of 0.91 (95% CI, 0.86-0.97), 0.94 (95% CI, 0.91-0.98), and 1.10 (95% CI, 1.06-1.14).²

REFERENCES

1. Steelandt, A, Hittinger, A, Kanagaratnam, L, et al. Urate lowering therapy in patients starting hemodialysis limit gout flares occurrence: ten years retrospective study. BMC Nephrol 25, 266 (2024). doi: 10.1186/s12882-024-03712-w
2. McCormick N, Joshi AD, Yokose C, et al. Pre-Diagnostic Amino Acid Metabolites and Risk of Gout, Accounting for Serum Urate: Prospective Cohort Study and Mendelian Randomization. Published online August 21, 2024. Arthritis Care Res. Doi:10.1002/acr.25420