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Addressing The Link Between Gout And Kidney Disease

Mar 3, 2023

Gout has been linked to kidney disease (CKD) through the filtration of uric acid through the kidneys. CKD is a known cause of gout, and gout may also lead to kidney disease. In the U.S., 1 in 10 people with CKD are reported to have gout. As gout and CKD are so closely related, it is essential that the protection of kidney function is an intervention to reduce gout symptoms.

Key Points:

  • A higher percentage of people with gout have CKD.
  • Testing kidney function in people with gout is vital as high uric acid levels may be signs of CKD.
  • Many people with kidney disease have undiagnosed and uncontrolled gout, which may lead to other complications and further disease progression.

Gout Overview

Gout is a common form of inflammatory arthritis and is characterized by sudden and intense attacks of joint pain. Gout is a chronic disease with no cure and can sometimes be challenging to control if there are any underlying health conditions. Gout may be effectively managed with medication and self-management strategies.

What causes gout and uric acid build-up?

Gout is caused by hyperuricemia, a condition where there is too much uric acid in the body. Hyperuricemia may not always cause gout. Uric acid is made in the body when it breaks down purines (natural chemicals found in every cell of the body). Purines are found in our foods and naturally occur in the body. Certain medications, such as those used to treat hypertension, may increase uric acid in the body.

When there is excess uric acid in the bloodstream, either from too much being produced or your body is unable to get rid of it effectively, uric acid crystals (monosodium urate) may build up in the body’s tissues, fluids, and joints. These urate crystals are what cause gout symptoms.

Symptoms of gout

Gout can be classified as either acute or chronic. In acute gout, only 1-3 joints are affected, with the big toe being the most common. During attacks, you may only feel symptoms, while after attacks, symptoms will disappear. If the attacks become more frequent and severe and last longer, it is said to be chronic. Chronic gout affects more than one joint and may result in permanent joint damage, stiffness, or deformity.

Symptoms of gout in the affected joint(s) may include:

  • Heat
  • Pain, usually sudden and intense
  • Redness
  • Inflammation (swelling)
  • Limited range of motion

These gout symptoms may occur suddenly and last days or weeks. Some people may only experience gout symptoms once, while others may have multiple attacks yearly. These attacks or flares are typically followed by a period of remission (weeks, months, years) without symptoms before they reoccur.

Kidney Disease and Gout, Is There a Connection?

Kidney disease is a common cause of gout development. Gout may lead to the development of kidney disease. These two diseases are connected as uric acid is filtered through the kidneys.

Chronic kidney disease (CKD) is characterized by the kidneys no longer being able to filter waste out of the body as effectively as they should. The waste products that the kidneys filter out the body includes uric acid, which naturally occurs in the blood. The stage of CKD depends on how well the kidneys can filter out the uric acid. When you have excess uric acid build up in the body, gout may occur.

As most people with early-stage CKD do not know they have the disease due to the lack of symptoms, gout may be used as a risk factor or warning sign of kidney disease. If you have gout, it is advised that you talk to your healthcare provider and be tested for kidney disease.

Can gout cause kidney failure? 

Although the connection is less established, there is evidence that gout may lead to the occurrence of kidney disease.

Gout is caused by excess uric acid in the bloodstream. When the blood is filtered through the kidneys, uric acid may build up and form monosodium urate crystals (MSU). When the urate crystals pass through the kidneys, they may cause damage resulting in scarring. This damage to the kidney is thought to result in kidney disease and failure, especially if the gout is left untreated.

Studies have found that compared with people who do not have gout, people with gout are:

  • 200% more likely to have ESRD or kidney failure.
  • 29% more likely to have advanced-stage CKD.

The frequent and common use of nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve the symptoms of gout attacks have shown to lead to the development of kidney disease over time. Thus, It is important to talk to your physician about how to manage your use of NSAIDs.

Living With Gout and Kidney Disease

Implementing interventions to help slow the disease progression of CKD may help reduce the risk of developing other health conditions. Some treatments and steps may be taken to help protect your kidney function and potentially lessen the severity or prevent gout attacks.

  • Maintain a healthy blood glucose (sugar) level. High blood sugar levels that are frequent and ongoing may cause damage to the nerves, blood vessels, and kidneys. Monitoring and keeping blood sugar levels balanced is important to minimize the risk of a gout attack.
  • Maintain a healthy blood pressure. Lowering your blood pressure is an important intervention in managing or slowing the progression of CKD. Your healthcare provider can help you with a treatment plan if you need to control your blood pressure.
  • Maintain a healthy weight. Being obese is a risk factor for developing gout. When you are overweight and have kidney disease, you risk developing gout. Your care team will help implement a kidney-friendly diet, monitor your weight, and track any changes.
  • Take your medication as prescribed by your healthcare professional. Certain medications used to treat gout (e.g., NSAIDs) are known to lead to kidney disease. It is important that you talk to your healthcare provider and ask what medications you can take for gout attacks that will not cause further damage to your kidneys.

Foods to avoid with gout and kidney disease 

Foods and drinks that are high in purines (e.g., organ meats, beer, shellfish, and products with high-fructose sugars) should be avoided or limited since they play a role in producing uric acid in the body.

A kidney-friendly diet is recommended instead and includes reducing sodium and protein intake according to your diet plan and consuming fruits, vegetables, and whole grains. Your healthcare team or dietician will provide you with an individual diet plan and help you determine what lifestyle changes you may need to help treat or manage gout risks with kidney disease.

Panoramic Health 

Panoramic Health is a physician-led organization that draws on +14 years of experience to provide patients and providers with unmatched clinical expertise. Our physicians, clinical experts, transplant directors, and PCP’s understand and know how to approach kidney disease best.

We provide a transformative approach to care delivery that is focused on delivering compassionate and personalized care via holistic interventions for all patients.

Our patient engagement rate is two to three times higher than the national average. This means our patients are engaged, have the resources to lead healthier lives, and take the necessary steps to slow CKD disease progression. Our patient’s quality of life and treatment outcomes benefit from our comprehensive care model, which provides holistic care.