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Dosing of antigout drugs in adults with CKD
Gout is a common inflammatory arthritis disorder in patients with CKD.
Although NSAIDs are the drugs of choice for the treatment of acute attack in patients with normal kidney function, NSAIDs should be avoided or used with caution in patients with CKD.
Corticosteroids orally, intravenously, intra-articularly, or indirectly via adrenocorticotropic hormone can be given safely in this setting.
Colchicine also can be used for the treatment of gout flare-up; however, the dose should be adjusted to 0.5 mg orally 2 to 3 times per day for patients with eGFR between 10 and 50 mL/min.
Intravenous colchicines is contraindicated in CKD because of the associated risk for multiorgan failure.
Recombinant urate oxidase (rasburicase) can be used in patients with hyperuricemia and have failed other standard oral antihyperuricemic drug therapy. No dosage adjustment is required in this setting.
Dosage Recommendations for Antigout Drugs in Chronic Kidney Disease
NORMAL KIDNEY FUNCTION | CKD STAGES 3–5 | HEMODIALYSIS | |
|---|---|---|---|
| Allopurinol | 300–400 mg | 25%–50% | 25% |
| Colchicine | 1 mg, then 0.5 mg q8h | 25% | Avoid |
| Corticosteroids | 40 mg | 100% | 100% |
| Febuxostat | 40–80 mg/day | 100% | NA |
| Rasburicase | 0.15–0.2 mg/kg | 100% | 100% |
CKD, Chronic kidney disease; NA, not applicable.
