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Serum urate levels and therapy in adults treated with long‐term dialysis: a retrospective cross‐sectional study
Author(s) -
Yeo Estella,
Palmer Suetonia C.,
Chapman Peter T.,
Frampton Christopher,
Stamp Lisa K.
Publication year - 2019
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14163
Subject(s) - medicine , dialysis , cross sectional study , retrospective cohort study , dialysis therapy , intensive care medicine , pediatrics , pathology
Background The management of gout in chronic kidney disease and end‐stage renal disease is challenging and remains controversial. There are limited data on the use of urate‐lowering therapy in people receiving dialysis. Aim To estimate the point prevalence of gout, gout treatment and achievement of target serum urate (SU) among adults treated with long‐term dialysis. Methods Three secular cohorts of adults receiving dialysis for at least 90 days on 1 February 2017, 1 January 2016 and 1 January 2015 were identified. Medical records were reviewed for SU concentrations. Results were compared between haemodialysis (HD) and peritoneal dialysis (PD), and participants prescribed and not prescribed urate‐lowering therapy. The percentage reduction in SU 24‐ and 48‐h post‐HD was estimated based on data from a previous study. SU concentrations were then used to estimate the percentage time the SU was <0.36 mmol/L using linear interpolation. Results Of 216 dialysis patients, 61 (point prevalence 28.2%, 95% confidence interval 22.35–34.8%) had a diagnosis of gout. The mean (SD) age among those with gout was 61 years (14.4), 46 (75.4%) were men and 18 (31.1%) identified as Māori or Pacific Island. Forty‐two (68.9%) were prescribed allopurinol (mean (SD) dose 116.0 ± 66.9 mg/day). 46% had a predialysis SU ≤0.36 mmol/L on less than 25% of occasions and 23% were below target on 76–100% of occasions. SU was below target 41% of time, with no statistically significant difference in those on HD or PD ( P = 0.39), and those prescribed or not prescribed allopurinol ( P = 0.55). Conclusions Gout is experienced by approximately one in four adults treated with dialysis and two‐thirds are prescribed allopurinol. A minority have SU at a target sufficient to prevent gout despite allopurinol and HD. A treat to target SU should be considered in those with SU above target.