Urate Lowering Therapy in Moderate to Severe Chronic Kidney Disease

MedicalResearch.com Interview with:

Gerald D. Levy MD Internal Medicine/Rheumatology Southern California Kaiser Permanente Downey, CA

Dr. Gerald Levy

Gerald D. Levy MD
Internal Medicine/Rheumatology
Southern California Kaiser Permanente
Downey, CA 

MedicalResearch.com: What are the main findings of your study?

Patients with hyperuricemia and chronic kidney disease (CKD)  improve when serum Uric Acid (sUA) is brought below 6mg/dl with urate lowering therapy.

We found a 6% improvement in this group compared to patients not at goal.

More importantly the stage of CKD appears to be important with CKD II showing approximately 3% who improve with nearly 10% of patients improving in the CKD III group.
We did not see benefit in those patients who are stage 4 CKD.

MedicalResearch.com:  You spoke on the need for rheumatologists to better educate primary care physicians about uric acid and renal disease. 

Response: Our study is consistent with others that show less than 50% of patients on allopurinol actually have the diagnosis of gout.  If we can get more primary care physicians (PCP) PCPs to make the diagnosis then they are more likely to order serum urate acid and hopefully adjust the urate lowering therapy appropriately.  The current situation is one where most patients do not get periodic serum uric acid tests and therefore are under treated.

MedicalResearch.com: You also spoke on a position paper by the ACR opposed to current guidelines from the ACP on uric acid. 

Response: Numerous studies have shown that  primary care physicians under diagnose and under treat this generally easily controlled disease.  This leads to unnecessary pain and lost function [including work days] by millions of patients.

It is unfortunate that two major organizations are giving mixed messages.  The methodology of the ACP is limited to randomized controlled studies whereas the ACR 2012 guidelines and the EULAR 2016 guidelines look at the entire body of literature including large epidemiological studies for its conclusions.

Our study shows the importance of normalizing the serum uric acid for its impact on CKD. Other studies show cardiac and cerebral benefits to normalizing serum uric acid.  To focus only on the aspect of acute gout attacks is likely to lead to more ER visits, with the associated costs, lost work and wages and patients who ultimately have renal, cardiac and cerebral problems that could be avoided, simply by using a well tolerated relatively inexpensive medication.  

MedicalResearch.com: Finally, what is the key take home message of this trial for clinicians? 

Response: Monitor patients with hyperuricemia and CKD.

Consider utilizing urate lowering therapies  in addition to the usual ‘tools’ of optimizing glucose and blood pressure control along with ACE and ARBs to stabilize and possible improve renal function.  

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.



Urate Lowering Therapy in Moderate to Severe Chronic Kidney Disease

Gerald D. Levy1,2, Craig Cheetham3, Nazia Rashid4 and Jiaxiao Shi31Internal Medicine/Rheumatology, Southern California Kaiser Permanente, Downey, CA, 2Rheumatology, Kaiser Permanente Southern California, Downey, CA, 3Research and Evaluation, Southern California Medical Group, Pasadena, CA, 4Pharmacy Analytic Services, Kaiser Permanente, Downey, CA

Meeting: 2016 ACR/ARHP Annual Meeting

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 19, 2016 by Marie Benz MD FAAD