BackgroundDiuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout. MethodsThis was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5 mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis.ResultsWe included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = − 0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = − 0.47, p = 0.833). There was no association with febuxostat (beta = − 0.116, p = 0.514).ConclusionDiuretics do not appear to have a significant impact on managing gout.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1559-2) contains supplementary material, which is available to authorized users.

BackgroundUse of diuretics is a common bystander in patients with gout, and it has been reported to impair response to allopurinol [1,2] and likely lead to treatment failure and refractoriness. However, after the introduction of new urate-lowering therapies (ULT) and treat-to-target strategies, whether this inconvenient effect of diuretics persists has not received critical attention to date.ObjectivesTo analyze the impact of the diuretic therapy on the response to ULT in patients with gout.MethodsRetrospective analysis of an inception cohort in patients with crystal-proven gout (Jan2014-Nov2016). Patients were classified according to the use of diuretics (loop and/or thiazide) at baseline. The primary outcome variables were the reduction of serum uric acid (SUA) levels and the achievement of different objectives of SUA (6, 5, and 4mg/dL); as secondary outcome variable the maximum dose of ULT was registered, as well as other clinical, analytical, and ULT-related data. A comparative analysis was performed according to the use of diuretics, using Student's t and chi-2 tests. Also, the analysis was stratified according to the ULT used.ResultsThe inception cohort included 225 patients with an average age of 65 years (SD 14.1), being 86.2% of them men. The median duration of gout at inclusion was 4 years (p25–75 1–10) and 21.3% presented tophi. At baseline, the median (p25–75) SUA and estimated glomerular filtration rate were 8.2 mg/dL (7.2–9.2) and 75.9 mL/min (27.2–88.3), respectively. A total of 98 patients (43.6%) were on diuretics mainly for hypertension (64.7%), heart failure (9.4%), and renal failure (5.9%). Follow-up data was available from 209 patients (92.9%), with a median 9 months of follow-up (4–14). ULT used was allopurinol in 172 patients (82.6%), febuxostat in 34 (16.5%), and benzbromarone in only 2 cases (0.9%). Regarding the baseline characteristics, patients on diuretics were older, had higher rates of females, hypertension, diabetes, and cardiovascular disease, and showed higher SUA and lower glomerular filtration rate. The table shows the outcomes comparison according to diuretic treatment, globally and stratified by type of ULT (excluding the two cases of benzbromarone). Except for a lower achievement of SUA<5 in the allopurinol subgroup, no significant differences were found either globally or by type of ULT.Outcome variableDiuretic therapyp NoYes Whole sample (N=209)N=117n=92– SUA reduction (mg/dL), mean (SD)3.2 (2.1)3.7 (2.5)0.196– SUA<6 (%)80.0%75.9%0.458– SUA<5 (%)61.0%50.6%0.126– SUA<4 (%)31.4%28.9%0.575Allopurinol (n=158)N=92N=66– SUA reduction (mg/dL), mean (SD)3.1 (1.9)3.2 (2.0)0.813– SUA<6 (%)80.6%74.2%0.337– SUA<5 (%)60.2%43.9%0.043– SUA<4 (%)28.0%21.2%0.334– Maximum dose (mg/day), mean (SD)316.5 (126.9)278.6 (121.8)0.053Febuxostat (n=33)N=14N=19– SUA reduction (mg/dL), mean (SD)3.7 (3.4)5.6 (3.1)0.147– SUA<6 (%)70.0%82.4%0.456– SUA<5 (%)70.0%76.5%0.711– SUA<4 (%)60.0%58.8%0.952– Maximum dose (mg/day), mean (SD)80.0 (16.3)80.0 (25.3)0.348ConclusionsDespite its high rate, diuretics cur...

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