How Your Kidneys Affect Gout: What You Need to Know

Gout and chronic kidney disease (CKD) share a complex and reciprocal relationship, as explained by three leading nephrologists: Jessica Coleman, M.D., Nissreen Elfadawy, M.D., M.S., and Abdul Abdellatif, M.D. In episode 2 of The Educated Patient’s “Managing Uncontrolled Gout: Insights from Top Doctors” series, they emphasize the importance of recognizing and managing gout in patients with CKD, highlighting challenges in treatment and the need for patient-provider collaboration.

Coleman, a nephrologist at Nephrology and Hypertension Medical Associates in South Carolina, explains that uric acid is a waste product primarily eliminated by the kidneys. In patients with CKD, uric acid can accumulate, increasing the risk of gout. She likens this process to a closet where excess items are hidden away, illustrating how the body deposits excess uric acid in joints when it is not efficiently removed.

Coleman stresses that patients with CKD require a tailored approach to gout treatment, beginning with active screening. Given the complexity of CKD and its associated comorbidities like hypertension and diabetes, gout can often be overlooked. Traditional oral urate-lowering therapies may be ineffective as kidney function declines, thus limiting treatment options. She encourages patients to actively communicate with their healthcare providers about gout flares, as accurate reporting can guide treatment adjustments.

Elfadawy, a staff nephrologist at University Hospitals Geauga Medical Center, reinforces the bidirectional relationship between gout and kidney function, explaining that kidney dysfunction can elevate uric acid levels, which in turn can worsen kidney health if left uncontrolled. She notes that common gout treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are often unsuitable for patients with CKD as they can further harm kidney function. Similarly, medications used for conditions like hypertension can exacerbate uric acid buildup.

She advocates for regular kidney function and uric acid monitoring, emphasizing the “treat to target” approach, where uric acid levels should be kept below 6 mg/dL to prevent crystal deposits. Newer treatment options beyond traditional oral medications, including infusions, offer promising success rates. She stresses the need for both patients and providers to take gout seriously, recognizing its metabolic impact beyond joint pain.

Abdellatif, faculty at Baylor College of Medicine and chief of nephrology at CLS Health, highlights the importance of multidisciplinary coordination in treating gout. He explains that many gout patients first see specialists like podiatrists or rheumatologists, yet nephrologists play a crucial role in long-term management. Since most gout cases stem from kidney dysfunction, collaboration among healthcare providers is essential. Abdellatif also notes a familial component to gout, observing its prevalence across multiple generations in some families. While genetic testing is not standard for gout, it can help identify underlying kidney conditions. He urges patients with a family history of gout to be proactive in monitoring their health.

Together, these experts underscore the need for comprehensive, individualized gout management in patients with CKD, emphasizing education, early screening and interdisciplinary care.