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

BACKGROUND: 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 1st February 2017, 1st January 2016 and 1st 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 hours post-haemodialysis was estimated based on data from a previous study. SU concentrations were then used to estimate the percentage time the SU was <0.36mmol/l using linear interpolation.

RESULTS: Of 216 dialysis patients, 61 (point prevalence 28.2%, 95%CI 22.35-34.8%) had a diagnosis of gout. The mean (SD) age among those with gout was 61years (14.4), 46 (75.4%) were men and 18 (31.1%) identified as Maori or Pacific Island. Forty-two (68.9%) were prescribed allopurinol (mean (SD) dose 116.0±66.9mg/day). 46% had a pre-dialysis SU ≤0.36mmol/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 haemodialysis. A treat to target SU should be considered in those with SU above target. This article is protected by copyright. All rights reserved.