Managing Gout 
in Patients With Chronic Kidney Disease


In late 2012, the ACR published new guidelines for gout management. Part one of the guidelines is dedicated to the nonpharmacologic and pharmacologic management of hyperuricemia, and part two addresses management of acute attacks and prophylaxis.5,6

In addition, the ACR guidelines emphasize recognizing comorbidities and discuss diet and lifestyle modifications, the elimination of offending agents, and therapy education. These guidelines also offer pharmacologic recommendations for the CKD patient with gout.  

Mary Rogers Sorey, ACNP-BC, works in the nephrology division at Duke University Medical Center in Durham, N.C.


  1. Choi HK, Mount DB, Reginato AM, et al. Pathogenesis of gout. Ann Intern Med. 2005;143:499-516.
  2. Krishnan E, Lienesch D, Kwoh CK. Gout in ambulatory care settingsin the United States. J Rheumatol. 2008;35:498-501.
  3. Keenan RT, O’Brien WR, Lee KH, et al. Prevalence of contraindications and prescription of pharmacologic therapies for gout. Am J Med. 2011;124:155-163.
  4. Fuldeore MJ, Riedel AA, Zarotsky V, et al. Chronic kidney disease in gout in a managed care setting. BMC Nephrol. 2011;12:36. Available at
  5. Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64:1447-1461. Available at

  6. KDOQI. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kidney Dis. 2007;49(2 Suppl 2):S12-S154. 

  7. Stevenson M, Pandor A. Febuxostat for the management of hyperuricaemia in patients with gout: a NICE single technology appraisal. Pharmacoeconomics. 2011;29:133-140.

  8. Hande KR, Noone RM, Stone WJ. Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. Am J Med. 1984;76:47-56.

  9. Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI 
clinical practice guidelines on hypertension and antihypertensive agents 
in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1-S290.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-S266.

  10. Ben-Chetrit E, Scherrmann JM, Zylber-Katz E, Levy M. Colchicine disposition in patients with familial Mediterranean fever with renal impairment. J Rheumatol. 1994;21:710-713.

  11. Wallace SL, Singer JZ, Duncan GJ, et al. Renal function predicts colchicine toxicity: guidelines for the prophylactic use of colchicine in gout. 
J Rheumatol. 1991;18:264-269.

  12. Juraschek SP, Kovell LC, Miller ER 3rd, Gelber AC. Association of kidney disease with prevalent gout in the United States in 1988-1994 and 2007-2010. Semin Arthritis Rheum. 2013;42:551-561.

This article originally appeared on Clinical Advisor