Drug therapy of gout combined with chronic kidney disease

Chronic kidney disease(CKD) is the most common comorbidity of gout that increasingly plagues patients these years. However, data from randomized controlled trials in patients with gout and CKD are limited, and there is no explicit treatment guidance in guidelines for management of patients with gout and CKD. The goals of gout treatment are to control pain and lower the level of serum urate. Though nonsteroidal anti-inflammatory drugs(NSAIDs) and colchicine are used to treat acute gout flares as the fisrt line medications, NSAIDs are not recommended in patients with CKD for the kidney injury. Similarly, the toxicity of colchicine is increased in patients with CKD that means the dosage should be decreased moderately based on the level of kidney function. We should also weigh the advantages and disadvantages for steroid hormone therapy, which suggests changes in immunotherapy might be necessary. Allopurinol, febuxostat, uricosuric agents and pegloticase are all effective agents for the hyperuricemia secondary to acute gout flares. Nevertheless, in patients with CKD, the efficacy of allopurinol is unsatisfied due to its limited dosage, and the pegloticase requires further study, while little research has been done on febuxostat in patients with creatinine clearance rate less than 30 ml/min. Key words: Gout; Hyperuricemia; Chronic kidney disease; Drug therapy