Rising Gout & Kidney Disease Rates Underscore Treatment Issues

March 22, 2022

Gout and kidney disease can be a lethal combination.

Kidney disease alone is the 10th leading cause of death in the United States, and one study reports that people with gout are about 80% more likely to die from kidney disease than are those who don’t have gout.

Though gout, a chronic and painful form of arthritis, has been around since ancient times, cases have surged in the U.S. and around the world. Some blame the Western diet, heavy on red meat, and a corresponding surge in obesity. But treatment challenges may also play a role.

Dispute Over Managing Uric Acid Levels

Uric acid levels in the blood are the common and sometimes dangerous connection between gout and kidney disease. And professional differences over how aggressively to manage these levels have separated large groups of physicians who treat patients with gout, kidney disease or both.

Some prominent physicians have voiced concern that the standards of the American College of Physicians on uric acid reduction targets are too conservative, compared with those of the American College of Rheumatology. In a speech at the American College of Rheumatology’s annual meeting last year, one expert characterized gout as one of the most mismanaged chronic conditions in medicine.

Other critics maintain that gout cases handled by primary care physicians too often only focus on relief from painful symptoms rather than on a long-range plan to manage the patient’s disease by decreasing uric acid levels.

The Gout-Kidney Disease Connection

The fundamentals of the uric acid connection between gout and kidney disease are not disputed. Gout develops when uric acid builds up in the body and crystallizes in the joints. When kidneys function normally, they filter out uric acid and other waste and remove it from the body as urine.

Kidneys affected by disease can’t adequately process uric acid in the bloodstream, however. As a result, one in 10 patients with chronic kidney disease also develops gout. And sometimes the process works in reverse. A patient’s gout may release enough uric acid into the bloodstream to overtax the kidneys, leading to kidney disease.

Since the questions raised about managing uric acid levels are relevant to both gout and kidney disease patients, patients might do well to talk with their health care providers about the strategy for managing their illnesses. And March, recognized as National Kidney Month, offers as good a time as ever to initiate that conversation.

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