Treatment of Gouty Arthritis Patients with Chronic Kidney Disease

Abstract

The previous studies found that patients with chronic kidney disease below stage 4-5 had more targeted uric acid levels than those with stage 4-5 (34.6% and 22.2% respectively), and patients treated by a nephrologist, most of the uric acid-lowering doses were not adjusted according to their current renal function. This descriptive study aimed to determine the factors related to the targeted treatment of gouty arthritis by collecting retrospective data of patients with gouty arthritis (ICD 10 M100-109 code) and chronic kidney disease which glomerular filtration rates less than 60 ml/min. The study samples were patients with chronic kidney disease who received treatment at Rak-Kor clinic, Nongkhai Hospital between 1st July 2010 and 31st December 2020. The factors involved in the treat-to-target of gouty arthritis, which uric acid levels were less than 5.0 mg/dL in patients with tophi and less than 5.5 mg/dl in patients without tophi, were analyzed by Chi-square test or Fisher’s exact test (95%CI, p<0.05). Of the 247 eligible patients, 84.2% of them achieved target uric acid levels. The factors associated with achieving treat-to-target for gouty arthritis patients with glomerular filtration rates less than 60 ml/min were body mass index, presence of tophi, dyslipidemia, renal calculi, duration of treatment, and drugs discontinuation (p<0.05). The glomerular filtration rates after treatment tended to be better than before treatment at all stages. However, it was statistically significant only in patients with chronic kidney disease stage 3 or 4 (p<0.05). In summary, the key factors to achieving targeted uric acid levels in patients with chronic kidney disease are the assessment of body mass index, underlying diseases, especially dyslipidemia and renal calculi, presence of tophi, and drug discontinuation for treatment planning go along with a gradual adjustment of uric acid-lowering drugs by the physician using the “Go low, Go slow” method to improve kidney function, reduce complications and improve quality of life of patients.