Urate-Lowering Therapy for Gout Patients May Protect Against Progression of Kidney Disease

In a large cohort study emulating a target trial, urate-lowering therapy (ULT) in patients with gout and stage 3 chronic kidney disease (CKD) achieving a serum urate level <6 mg/dL did not increase risk and was in fact associated with a reduced risk of progression to severe or end-stage kidney disease, researchers reported in JAMA Internal Medicine.

For this retrospective cohort study the investigators utilized the IQVIA Medical Research Database spanning 2000 to 2023, which included 14,792 patients aged 40–89 years diagnosed with both gout and CKD stage 3, and applied a target trial emulation approach. Patients were stratified based on whether they achieved a target serum urate level of <6 mg/dL through ULT. The primary outcome was progression to severe or end-stage kidney disease, defined by either: an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² on 2 separate occasions at least 90 days apart within 1 year; or a diagnostic code indicating CKD stage 4 or 5, dialysis, or kidney transplant.

Of the 14,792 participants (mean \[SD] age, 73.1 \[9.5] years; 62.3% male), the 5-year risk of severe or end-stage kidney disease was lower in patients who achieved the target urate level compared to those who did not (10.32% vs 12.73%). The adjusted risk difference was -2.41% (95% CI, -4.61% to -0.21%), with an adjusted hazard ratio (HR) of 0.89 (95% CI, 0.80–0.98), remaining within the prespecified noninferiority margin (HR 1.2).

This study supports the safety and potential benefit of targeting serum urate <6 mg/dL with ULT in patients with gout and stage 3 CKD. Contrary to clinical hesitancy, ULT did not elevate risk for end-stage kidney disease, and instead may provide renal protection.

Wang Y, Dalbeth N, Terkeltaub R et al. Target serum urate achievement and chronic kidney disease progression in patients with gout and kidney disease. JAMA Intern Med. 2025;185(1):74-82. doi: 10.1001/jamainternmed.2024.6212