Gout and chronic kidney disease
Gout and chronic kidney disease (CKD) frequently coexist, as both of these diseases are affected by the high levels of uric acid in the body. Many people with CKD have uncontrolled gout that can exacerbate their condition and lead to other complications. If you are prone to gout, you are at an increased risk of developing kidney disease and vice versa.
How can kidney disease lead to gout?
Normal kidneys filter waste and excess fluids from the blood. However, kidney function declines when you have chronic kidney disease. The ability of the kidneys to remove excess uric acid effectively and efficiently is compromised.
Waste and minerals build up in the blood over time, worsening your kidney condition. Uric acid is a waste product found in the blood when purines are broken down in the digestive system. Most uric acid dissolves in the blood and passes through the kidneys. Uric acid leaves in the body through urine. Nevertheless, when uric acid remains in the body for too long, it can crystallize and cause gout.
How can gout contribute to kidney disease?
There is evidence that gout can lead to kidney disease, although the connection is less established. Gout happens when there is a great amount of uric acid crystallizing, resulting in joint inflammation. These crystals technically consisted of sodium urate, but they are generally referred to as uric acid crystals. Crystals often appear in the joints, but they also accumulate in the outer ear, the skin near the joints, and the kidneys.
The crystals can cause damage and scars as they pass through the kidneys. This damage to the kidneys is thought to contribute to kidney disease and failure over time, especially if the gout is left untreated. However, some people with high concentrations of uric acid levels in the blood – called hyperuricemia – do not develop gout and even when they do, they can go for years without manifesting any symptoms.
Uric acid can still build up in the body even with normal kidney function. If the kidneys couldn’t filter uric acid effectively, uric acid can accumulate in the blood, which can lead to gout.
What causes gout?
The body produces uric acid when it breaks down purine, a chemical found in the body and foods we consume. Even normal kidneys can have a hard time passing excess uric acid from the body. As a result, uric acid settles in the joints, causing gout. They can also lead to uric acid kidney stones when they settle in the kidneys. Gout symptoms can get worse, more commonly known as flares, but there are also times when symptoms don't occur (referred to as remission). Repeated gout episodes can result in gouty arthritis, a worsening form of arthritis.
Risk factors of Gout
Your risk of developing gout increases if you have high levels of uric acid in the body. Among the factors that elevate your uric acid level include:
Diet - Eating foods high in purines can raise your uric acid level. Foods high in purine include organ and glandular meats such as liver, kidney. Eating Pancreas and thymus (collectively known as sweetbreads) can also contribute to gout development.
Red meat like beef, lamb, and pork, and some types of seafood such as shellfish, sardines, and tuna have high levels of purines. Vegetables that can increase blood levels of uric are asparagus, spinach, and cauliflower.
However, these vegetables don't increase the risk of developing gout or persistent gout attacks.
Alcohol consumption - Different types of alcohol have varying amounts of purines. Beer has the highest purine content and spirits the lowest. Several studies have shown that consuming alcohol is a major risk factor for gout.
Weight - The body produces more uric acid when there is excess weight. According to Arthritis & Rheumatology, overweight people were 85% more likely to have hyperuricemia compared to those with a healthy body mass index (BMI).
Meanwhile, those who are obese were 2.7 to 3.5 times more likely to develop hyperuricemia.
Existing Conditions - Diabetes, obesity, metabolic syndrome, kidney disease, and heart conditions raise your risk of developing gout.
Medications - Your medication may contribute to your increased uric acid levels. Using medications such as aspirin, and angiotensin-converting enzyme (ACE) inhibitors and beta-blockers can increase uric acid level so is taking medications to control hypertension.
Age and Sex
Age and Sex - Women tend to have lower uric acid levels which mean men are more prone to developing gout. However, after menopause, women's uric acid level increases. Moreover, men are more likely to develop gout at an early age between ages 30 and 50.
As mentioned, some people with a high level of uric acid don't develop gout. Those who do can experience various symptoms. A gout episode is called a gout attack, which can be very painful and happen suddenly, mostly overnight. The symptoms can be:
- Hot and very tender feeling in the joints. It can come to the point of being unbearable to touch
- Swelling in and around the affected joint.
- Red, shiny skin over the affected joints
- peeling, itchy and flaky skin as the swelling goes down.
A gout episode can last a week or two. Some people can have frequent hourly attacks, while others can go years between gout attacks. Attacks may become more frequent and last longer if left untreated. Gout episodes can occur in the same affected joints or can affect different joints.
How is Gout Treated?
Schedule an appointment if you suspect symptoms similar to gout for proper treatment. Gout treatment is categorized into two, focusing on two different problems. The first type of treatment addresses the pain and inflammation related to gout episodes. The second treatment lowers the uric acid level in the blood. The type of medication you should take depends on the frequency and severity of your gout symptom,s as well as other health conditions you may have.
Managing Gout and Chronic Kidney Disease
Managing gout when you have chronic kidney disease can be challenging, as some gout medications can affect your kidney disease. Further research is still needed to address gouty arthritis and CKD. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are recommended among the treatments for acute gouty arthritis episodes. However, CKD patients aren’t recommended taking NSAIDs since they can worsen or cause acute kidney injury. Meanwhile, the dosage for the pill colchicine to treat gout is lowered for CKD patients. Note: Before taking any medicines, talk to your primary health care provider to ensure they are safe for your kidneys.
Besides taking medications, changing your lifestyle can help manage your gout attack symptoms or prevent them from happening. A few lifestyle changes you can do include:
- Reduce consuming food and drinks high in purine. Eating less animal protein minimizes the uric acid level in the body, decreasing the risk of gout flares and kidney stones.
- Stay hydrated, unless your doctor recommended restricting your fluid.
- Manage health conditions such as high blood pressure, obesity, high blood sugar, and heart disease. These conditions are risk factors for gout.
- Review medication and supplements with your healthcare professional, since some medications are known to impact the level of uric acid.
- Sweat it out to manage weight and blood pressure. (Check in with your doctor before working out).
- Reduce alcohol intake, especially beer, due to its high purine content.
The Bottom line
Chronic Kidney disease is a comorbid condition that can cause other diseases, such as gout, that can be painful. Currently, data addressing CKD and gout is limited, as some gout medications can worsen kidney disease. Talk to your primary healthcare provider beforehand prior to taking any gout medications to ensure that they don’t affect your kidney function. Other than the use of medications, one way to manage gout episodes is through lifestyle changes.
Gout - https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
Gout and Kidney Disease - https://www.kidney.org/atoz/content/gout/gout-kidney-disease#treatment
The Nephrology Perspective Management of gouty arthritis in patients with chronic kidney disease - https://openurologyandnephrologyjournal.com/VOLUME/9/PAGE/7/FULLTEXT/
Management of Acute and Chronic Gout - https://pubmed.ncbi.nlm.nih.gov/22960848/
Treatments for gout - https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/complications/gout/treatments-for-gout/
Management of Gout and Hyperuricemia in CKD - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5572666/