# Monitoring and Management of Uric Acid Therapy in Gout and Chronic Kidney Disease: A Single-Center Retrospective Study

## TL;DR

This study found that many gout patients, especially those with kidney disease, are not properly monitored or treated for high uric acid levels.

## Contribution

The study provides new insights into real-world adherence to urate-lowering therapy guidelines in gout patients with CKD.

## Key findings

- Only 48.3% of patients had uric acid levels monitored within six months of starting therapy.
- Over half of patients with elevated uric acid levels did not receive dosage adjustments.
- CKD stage did not significantly affect monitoring or dose adjustment rates.

## Abstract

Background

Gout commonly coexists with chronic kidney disease (CKD) due to reduced renal excretion of uric acid (UA). Guidelines recommend regular monitoring and dose adjustment of urate-lowering therapy (ULT), but the rate of adherence to these guidelines is not well established. Our study aimed to determine adherence to ULT guidelines in gout patients at our institution. In particular, we sought to assess the effect of CKD as well as other comorbidities on the prevalence of ULT guideline adherence.

Methods

We conducted a retrospective cohort study of 5,985 gout patients at our institution initiated on allopurinol between 2015 and 2020. Inclusion criteria were age over 18, a gout diagnosis, and a new allopurinol prescription. The primary outcome was UA monitoring within six months of therapy initiation. A secondary outcome was the prevalence of dose adjustments made by providers in response to a UA level above target.

Results

Only 48.3% (n = 2,889) of patients had UA levels monitored within six months. CKD stage did not significantly impact monitoring rates (p = 0.059). In patients with elevated UA levels (>6 mg/dL), 54.3% (n = 1,011) of patients had no dosage adjustments.

Conclusions

Significant gaps exist in adherence to ULT guidelines; nearly half of patients did not undergo recommended UA monitoring. Over half of patients with elevated uric levels did not have dosage adjustments. CKD stage did not affect the likelihood of UA monitoring or dose changes in persons with elevated UA levels.