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Understanding

UNDERSTANDING GOUT
Your
AND YOUR KIDNEYS
Hemodialysis
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UNDERSTANDING GOUT AND YOUR KIDNEYS

WHAT IS GOUT? Gout happens if a substance called


uric acid gets too high in your blood.
Gout is a common form of arthritis.
Everyone has small amounts of uric
It can cause pain, swelling, and
acid in their blood. It comes from
redness in your joints. Gout usually
two places—the normal breakdown
begins in the big toe, but can strike
of your body’s cells and certain
other joints such as the ankle, knee,
foods. At normal levels, uric acid
wrist, fingers, or elbow. Usually
does not cause any damage. But if
only one joint is affected, but some
the levels get too high, it can form
people may have gout in more than
sharp crystals that build up in your
one joint, especially if it is not found
body’s joints and cause pain. The
and treated.
medical term for high blood urate
levels is hyperuricemia.
DID YOU KNOW?
• About 8.3 million U.S. adults HOW DOES URIC ACID
(3.9 percent) are living with
gout today and up to 10% of
CAUSE GOUT?
people worldwide may have Whenever you eat or drink
gout. Gout is the most common something, your body pulls out the
form of arthritis. good stuff like vitamins, and gets
rid of the waste. One of those
• Gout puts you at risk for kidney
waste products is uric acid. It is
disease. Up to 20% percent of
made when your body breaks down
people with gout have mild to
purines, which is found in certain
moderate kidney disease.
foods. Uric acid also comes from the
• Having kidney disease puts you natural breakdown of cells. When
at risk for gout. It is the third cells in your body die, they release
most common risk factor for purines.
gout.
Healthy kidneys are filters. They
• A recent study found that 64% remove uric acid and other waste
of kidney patients with gout products from your blood. The
were not being treated for it waste products leave your body
and about 80% of these patients through urine. However, if more
had uncontrolled gout. uric acid is made than the kidneys
can remove, high uric acid levels
WHAT CAUSES GOUT? can happen. If too much builds up,
it can turn into crystals that settle in

American Association of Kidney Patients: Understanding Gout and Your Kidneys 3


your joints. This can cause a gout the most reliable test for gout
attack. and is considered the gold
standard.
• Blood test. A blood sample
WHAT ARE THE SYMPTOMS is taken to see how much
OF GOUT? uric acid is in your blood,
A gout attack can happen without although high levels don’t
warning. Most often, pain begins always mean gout. Some
suddenly in one or more joints, people can have high levels
usually at night. Often the joint in their blood and never get
swells, feels warm, becomes painful, gout.
and the skin over the joint may look • Imaging tests. X-rays,
red, tight, and shiny. Pain and ultrasound, CT scans can also
swelling usually peaks within 12 to be helpful in some people.
24 hours, and gets better within a X-rays are used to rule out
few days to several weeks. other causes of joint swelling.
The good news? Treatment can help Ultrasound and CT scans are
shorten a gout attack and ease pain. used to look for urate crystals
The earlier treatment is started, the in a joint.
better. Gout attacks are also called
flare-ups.
IS GOUT SERIOUS?
Gout is a serious disease that needs
HOW DO I KNOW I HAVE to be found and treated. Without
treatment, over time, gout attacks
GOUT? (also called flare-ups) become
If you have symptoms, talk to more painful and happen more
your healthcare provider. Your often. Another problem? Swollen
healthcare provider will give growths (called tophi) can form
you a physical exam, ask about in the joints, under the skin, in
your symptoms, and explore your bones or cartilage, or in the fluid-
medical history. You may be given filled sacs that cushion the body’s
some tests: tissue (called bursae). Tophi are
not usually painful, but they can
• Joint fluid test. A needle
become inflamed and cause other
is used to take fluid from a
problems. As gout progresses, it can
joint. The fluid is looked at
destroy joints forever; limiting your
under a microscope to see if it
ability to move and affecting your
has uric acid crystals. This is
ability to do normal, day-to-day

American Association of Kidney Patients: Understanding Gout and Your Kidneys 4


activities. Gout can also lead to loss • ACR (albumin-to-creatinine
of kidney function. ratio) is a urine test that shows
if protein (albumin) levels are
too high, which may mean
HOW DOES GOUT HURT kidney damage.
MY KIDNEYS?
Uric acid usually affects joints like WHO IS AT RISK FOR
the big toe, but crystals can also
form in your kidneys or in the tubes GOUT?
that carry urine from your body. It is not fully known why some
Kidney stones can develop and hurt people are more likely to get gout,
the kidneys by: but some things can increase your
• Blocking the kidneys from risk.
removing waste products, • Gender and age. Gout is
which can cause infection more common in men than
• Scarring the kidneys with women up to age 60. In men,
their sharp edges it usually happens between
the ages of 30 and 45. In
This can lead to kidney disease women, it usually happens
or kidney failure. There is also after menopause.
evidence that high uric acid levels
alone can hurt your kidneys, aside • Family background. You
from the damage caused by kidney are more likely to get gout
stones. if other members of your
family have it.
• Lifestyle. Being overweight
SHOULD I BE TESTED FOR and drinking too much
KIDNEY DISEASE? alcohol can put you at risk
for gout, especially drinking
Yes. Gout puts you at risk for kidney beer, whiskey, gin, vodka, or
disease and kidney failure. Ask your rum. The more alcohol you
healthcare professional for these drink, the higher your risk.
two simple tests:
• Diet. Drinking sugary drinks
• GFR (glomerular filtration or eating too much red meat,
rate) is a blood test that checks organ meat, and some types
how well your kidneys are of seafood can put you at
filtering waste products from risk.
your blood.

American Association of Kidney Patients: Understanding Gout and Your Kidneys 5


• Medicine. You may have cause higher levels of uric
a higher risk if you take acid in the blood. These
certain medicines, such as include kidney disease,
water pills (called diuretics), kidney failure, high blood
low-dose aspirin, and some pressure, diabetes, and other
anti-rejection drugs used disorders.
by people who have had a
kidney transplant or other
organ transplant. IS MY RISK FOR GOUT
• Recent surgery or trauma. HIGHER IF I HAVE KIDNEY
Surgery, radiation therapy, or
a sudden, severe illness can
DISEASE?
trigger a gout attack. Yes. Your kidneys do many
important jobs that keep you
• Other health problems.
healthy. Among other things, they
Certain health problems can
balance your body’s fluids, help

6 American Association of Kidney Patients: Understanding Gout and Your Kidneys


make red blood cells, and clean
waste products from your blood.
When you have kidney disease, it
means your kidneys are damaged.
They cannot do these jobs well.
They cannot remove enough waste
products like uric acid from your
blood. As a result, your uric acid
levels can get too high, and gout can
happen.

not be enough to control gout.


CAN GOUT BE TREATED? Most people will need special
Gout is a serious disease, but it can medicine to:
be treated. Over time, treatment
- Reduce pain during a gout
will help gout flares be less painful,
attack
happen less often, and even stop
coming back (called remission). - Lower the level of uric
Treatment usually involves: acid over time and help
keep future attacks from
• Keeping serum urate levels
happening
in check. Having your serum
urate levels checked regularly There is no single treatment that is
is very important. Most right for everyone. Your treatment
people with gout need to choices will depend on many things,
keep uric acid levels under including how well your kidneys
6 mg/dL. Some people with work and whether you have other
severe gout or tophi may health problems.
need to keep uric acid levels
even lower—under 5 mg/dL.
• A healthy lifestyle. This IF I HAVE KIDNEY
may include regular exercise, FAILURE, WILL MY
losing weight, limiting
purine-rich foods such as red DIALYSIS TREATMENT
meat and shellfish, avoiding CONTROL GOUT?
alcohol and sugary drinks, Dialysis is a process that filters
and not smoking. (cleans) your blood when your
• Taking medicine. A healthy kidneys no longer do this well. It is
lifestyle is important, but may one of the basic forms of treatment

American Association of Kidney Patients: Understanding Gout and Your Kidneys 7


for kidney failure. Dialysis cleans naproxen. NSAIDS can make
waste products like uric acid from your kidney disease worse, so
your blood, but usually cannot people with kidney disease or
remove enough to stop gout. Most kidney failure should not take
people on dialysis with gout still them without consulting their
need special medicine to keep uric healthcare provider.
acid levels in check. Medicine to keep future attacks
from happening includes:

WHICH MEDICINES ARE • Allopurinol and Febuxostat


are considered “first-choice”
USED TO TREAT GOUT? medicines. Both pills work
Medicine to reduce pain during a by helping to block uric acid
gout attack includes: from being produced. People
• Colchicine is a pill that helps with kidney disease may
reduce pain and swelling require a dose adjustment.
from gout. It works well, • Probenecid and Lesinurad
but can cause side effects in are pills that help your
some people, such as nausea, kidneys remove uric acid
vomiting, or diarrhea. People from your body. However,
with kidney disease or kidney neither is recommended for
failure can use this medicine, people with moderate or
but you will be given advanced kidney disease.
(prescribed) a lower dose to • Pegloticase is given as an IV
prevent the side effects of infusion into your blood to
colchrine. help break down uric acid
• Corticosteroids can be given in your body. An IV infusion
to reduce pain and swelling. means the medicine is sent
They can be taken as a pill, or directly into a vein using a
given as a shot in your blood needle or tube. Pegloticase
or directly into the affected can be useful for people
joint. with severe gout or those
• Nonsteroidal anti- who do not respond to other
inflammatory drugs (also treatments. It is the most
called NSAIDS) are pills powerful medicine to lower
that help reduce pain and uric acid and can be used in
swelling. Examples include patients with kidney disease
aspirin, ibuprofen, and without adjusting dosage.

8 American Association of Kidney Patients: Understanding Gout and Your Kidneys


WHAT ELSE CAN I DO TO
PREVENT GOUT FLARES?
• Exercise and keep a healthy
weight
• Stay hydrated. Drinking
water can help flush uric
acid from your system, but
most people with kidney
failure must limit how much
SUMMARY
they can drink. Ask your
healthcare provider how • Gout is a form of arthritis
much fluid you can have. that causes joint pain and
swelling. It is a serious
• Eat healthy meals with plenty
disease that requires
of fruits, vegetables, whole
treatment.
grains, and low-fat dairy
products • Gout happens if a substance
called uric acid gets too high
• Do not smoke
in your blood. Having high
• Limit alcohol, especially beer levels of uric acid in your
• Limit organ meats, red meats, blood is called hyperuricemia.
and shellfish • High levels of uric acid can
• Limit foods and drinks that harm your kidneys and lead
are high in sugar, especially to kidney disease or kidney
high fructose corn syrup failure.
• Take all your medicines as • People with kidney disease or
instructed kidney failure have a higher
risk for gout.
• Treatment for gout usually
includes lifestyle changes,
diet, and taking medicine.
• With treatment, most people
can control painful symptoms
and enjoy a normal lifestyle.

American Association of Kidney Patients: Understanding Gout and Your Kidneys 9


WORDS TO KNOW

Anti-rejection medicine: Inflammation: Swelling that


Medicine taken to keep the happens when parts of your body
body from rejecting a newly become infected or injured.
transplanted organ.
IV infusion: When medicine is
Arthritis: An inflammation of the given to you directly into a vein
joints that usually causes pain. using a needle or tube.
Diabetes: A disorder in which the Kidney disease: The loss of some
body either cannot make insulin or all of your kidney function.
or cannot use it properly. Insulin
is a hormone that controls how Kidney failure: The stage of
much sugar is in your blood. kidney disease at which dialysis
or a transplant is needed to stay
Dialysis: A process that filters alive.
(cleans) your blood when your
kidneys no longer do this well. Kidney transplant: An operation
It is one of the basic forms of that places a healthy kidney in
treatment for kidney failure. your body. It is one of the basic
forms of treatment for kidney
Diuretics: A type of medicine failure.
that helps your body get rid of
unneeded water and salt. Menopause: When a woman
stops having menstrual periods
Gout: A form of arthritis that forever.
causes pain and swelling.
Remission: Disappearance of the
High blood pressure: The force signs and symptoms of a disease.
of blood against the wall of your Remission can be temporary or
blood vessels. High blood pressure forever.
means the force is consistently
higher than what is healthy. Symptoms: A physical or mental
change that indicates illness or
Hyperuricemia: An excess of uric disease.
acid in the blood.
Uric Acid: A normal waste
Infection: The presence of an product that comes from the
organism like bacteria that causes breakdown of your body’s cells
pain, swelling, redness, and and certain foods.
sometimes fever.

10 American Association of Kidney Patients: Understanding Gout and Your Kidneys


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