Hæmodialysis in the Treatment of Gout

Duncan, Howard; Elliott, Walter; Horn, D. B.; Kerr, David; Pearson, D. T.; Robson, Alan M.

doi:10.1016/s0140-6736(62)92253-5

Cited by 11 publications

(10 citation statements)

References 12 publications

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“…Subsequent treatment with uricosuric drugs resulted in a significant reduction of uric acid levels. Similar effective results in the removal of uric acid in cases of acute renal failure had been previously reported by Goldberg et al (21), by Firmat et al (22), and by Duncan et al (23).…”

Section: The Artificial Kidneysupporting

confidence: 85%

Etiology and Treatment of Gout—modern Concepts

Riccitelli

1968

J American Geriatrics Society

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Gout, one of the oldest recorded syndromes in medical history, is still a biochemical mystery. Primary gout is characterized by a derangement in purine metabolism and an elevated concentration of uric acid in the blood. Gout may also occur secondarily in diseases associated with reduced urinary excretion of uric acid or increased nuclear breakdown in body tissues. The metabolic abnormality in primary gout is probably an inherited trait, though this has not been proved. The differential diagnosis of any swollen painful joint should always include gout. The most important diagnostic signs of gout are sudden periodic attacks of acute arthritis, an elevated level of serum uric acid, relief of pain by a therapeutic trial of colchicine and, later in the course of the disease, the presence of tophi around the joints or urate crystals in the synovial fluid. Renal damage is one of the major complications of chronic tophaceous gout and a frequent cause of death. Proteinuria is often the only manifestation of early renal involvement. Treatment is discussed from the standpoints of diet, drug therapy, use of the artificial kidney, and the surgical excision of tophi. Described under drug therapy are the effects of colchicine (still the drug of choice for acute attacks), phenylbutazone, ACTH, corticosteroids, indomethacin, allopurinol, and the uricosuric agents (probenecid, salicylates and sulfinpyrazone).

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Section: The Artificial Kidneysupporting

confidence: 85%

Etiology and Treatment of Gout—modern Concepts

Riccitelli

1968

J American Geriatrics Society

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“…It has been suggested that dialysis is sufficient to lower SU and thereby adequately control gout so that urate‐lowering therapy is not required . However, in this study, only 23% of individuals were below target urate for at least 75% of measurements.…”

Section: Discussionmentioning

confidence: 60%

“…Even less is known about gout in dialysis patients as limited studies have been published. Some studies have suggested that urate‐lowering therapy (ULT) is not necessary in this group of patients as dialysis should be sufficient to lower SU and prevent gout flares . However, no studies have specifically examined whether people with gout on long‐term dialysis achieve recommended treatment targets for people with gout.…”

Section: Introductionmentioning

confidence: 99%

Serum urate levels and therapy in adults treated with long‐term dialysis: a retrospective cross‐sectional study

Yeo

Palmer

Chapman

et al. 2019

Internal Medicine Journal

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Background The management of gout in chronic kidney disease and end‐stage renal disease is challenging and remains controversial. There are limited data on the use of urate‐lowering therapy in people receiving dialysis. Aim To estimate the point prevalence of gout, gout treatment and achievement of target serum urate (SU) among adults treated with long‐term dialysis. Methods Three secular cohorts of adults receiving dialysis for at least 90 days on 1 February 2017, 1 January 2016 and 1 January 2015 were identified. Medical records were reviewed for SU concentrations. Results were compared between haemodialysis (HD) and peritoneal dialysis (PD), and participants prescribed and not prescribed urate‐lowering therapy. The percentage reduction in SU 24‐ and 48‐h post‐HD was estimated based on data from a previous study. SU concentrations were then used to estimate the percentage time the SU was <0.36 mmol/L using linear interpolation. Results Of 216 dialysis patients, 61 (point prevalence 28.2%, 95% confidence interval 22.35–34.8%) had a diagnosis of gout. The mean (SD) age among those with gout was 61 years (14.4), 46 (75.4%) were men and 18 (31.1%) identified as Māori or Pacific Island. Forty‐two (68.9%) were prescribed allopurinol (mean (SD) dose 116.0 ± 66.9 mg/day). 46% had a predialysis SU ≤0.36 mmol/L on less than 25% of occasions and 23% were below target on 76–100% of occasions. SU was below target 41% of time, with no statistically significant difference in those on HD or PD (P = 0.39), and those prescribed or not prescribed allopurinol (P = 0.55). Conclusions Gout is experienced by approximately one in four adults treated with dialysis and two‐thirds are prescribed allopurinol. A minority have SU at a target sufficient to prevent gout despite allopurinol and HD. A treat to target SU should be considered in those with SU above target.

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“…Other special indications for dialysis Dialysis has been used in the treatment of gout (Duncan et al, 1962(Duncan et al, , 1963Goldberg et al, 1962).…”

Section: Advanced Uraemiamentioning

confidence: 99%

The management of acute reversible intrinsic renal failure

Blagg

1967

Postgraduate Medical Journal

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Hæmodialysis in the Treatment of Gout

Cited by 11 publications

References 12 publications

Etiology and Treatment of Gout—modern Concepts

Etiology and Treatment of Gout—modern Concepts

Serum urate levels and therapy in adults treated with long‐term dialysis: a retrospective cross‐sectional study

The management of acute reversible intrinsic renal failure

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