Five things people living with kidney disease should know about gout

When you think of gout, you most likely think of Benjamin Franklin and big toes. You're not far off — the Founding Father frequently wrote of his gout episodes, and gout can affect the joints, which includes the toes. 

The kidneys and gout are intertwined. So, if you're a person living with kidney disease, it's important to get knowledgeable about gout, which is an inflammatory arthritis caused by a build-up of uric acid in the joints. Gout is on the rise, with a high percentage of those individuals with the disease facing incorrect or inadequate treatment. 

Education is key to managing gout. The Gout Education Society is dedicated to improving the quality of life of those with gout by empowering them with the knowledge they need. 

The connection between gout and kidney disease

Kidney disease can lead to gout since damaged kidneys from kidney disease may not be able to filter uric acid out of your bloodstream. Likewise, gout can increase your risk of kidney disease since uric acid crystals can damage the kidneys. In fact, one out of 10 people with chronic kidney disease also has gout. Managing one condition can impact the progression of the other, allowing for a better quality of life for anyone living with either disease. 

Symptoms and diagnosis

If you are a person living with kidney disease, it is important to recognize gout symptoms for early diagnosis and treatment. Common symptoms include swelling, tenderness, stiffness and redness, often starting in the big toe. Clinical diagnosis typically involves blood tests to measure uric acid levels and imaging tests (usually with an ultrasound) to detect tophi (deposits of uric acid crystals) in the joints. However, the gold standard diagnosis tool is to have synovial fluid (the fluid found in your joints) extracted from an inflamed joint and examined for uric acid crystals under a microscope. 

Impact of gout on kidney health

Gout can make kidney disease worse, and vice versa. Uric acid crystals can form painful kidney stones that can prevent the kidneys from removing waste in the bloodstream, which can lead to infection and scarring. This can lead to chronic kidney disease (CKD) and even kidney failure if not properly managed. 

Management and treatment

Medicines, lifestyle changes and regular monitoring can help you effectively manage gout. Urate-lowering therapies (treatments aimed at reducing uric acid levels in the blood), like allopurinol and febuxostat help lower uric acid levels and can help control gout. As gout is chronic, these medicines are often taken for life. You should also maintain a healthy weight for you, follow a healthy food and fluid plan, drink plenty of water, and avoid excessive alcohol and high fructose corn syrup. Additionally, it's crucial to regularly monitor your uric acid levels and kidney function. A good benchmark to follow is to see your doctor every six months to have your uric acid levels tested and to aim for a level below 6.0 mg/dL. At this level, your body will begin the process of dissolving deposits of uric acid and the frequency of flares will gradually be reduced.

Lifestyle adjustments and preventative measures

Changes to your lifestyle and food and fluid plan aren't the end-all, be-all to managing gout, but they can positively impact risk factors associated with the disease. Maintaining a blood pressure below 130/80; keeping a blood sugar level of 80 mg/dL to 130 mg/dL; eating a balanced diet rich in fruits, vegetables, and whole grains; and engaging in regular physical activity are all lifestyle adjustments you can make to manage gout. It's also important to take medicines as prescribed and talk openly to your health care provider(s) about both conditions. 

If you're interested in learning more about gout and kidney disease, visit the Gout Education Society website and order patient resources free of charge. You can also visit AKF's gout page for more information about the connection between gout and kidney disease and how to manage these conditions.