Ab0110 Practice Patterns of Uric Acid Lowering Therapies in Patients With Chronic Kidney Disease and Potential Undesirable Clinical Outcomes

Background: Patients with progressive chronic kidney disease (CKD) have a higher risk of developing severe gout and tophaceous deposits.1 Treating patients with CKD and gout is challenging because of the lack of data to guide management in this specific population which often leads to suboptimal treatment of patients with gout and impaired renal function.2 Objectives: This study aimed to evaluate the use of uric acid lowering therapies (ULT) and presence of undesirable clinical outcomes in patients with CKD stage ≥ 3. Methods: A cross-sectional study was conducted using an online patient database that collects de-identified clinical information of patients seen in a single academic institution. The study period was from 1/1/2013 through 6/30/2023. The following diagnoses, diagnosis groups, medications, and codes were used to extract the data: gout, chronic renal failure, chronic kidney disease, N18.30 (CKD stage 3), N18.4 (CKD stage 4), N18.5 (CKD stage 5), N18.6 (End Stage Renal Disease), allopurinol 100 mg, allopurinol 200 mg, allopurinol 300 mg, febuxostat 40 mg, febuxostat 80 mg, L51.1 (Stevens-Johnson Syndrome, SJS), D61.818 (pancytopenia), R74.01 (transaminitis), I21.9 (acute myocardial infarction), and I63.9 (stroke). Absolute numbers and percentages to the hundredths place are reported. Bivariate analysis was performed using X2 on STATA 17 NP. Results: A total of 7,231 patients with gout and CKD stage ≥ 3 were identified during the study period. Patients with CKD stage 3 and 4 were the most prescribed ULT (72.29% and 70.56%, respectively) as opposed to advanced stages of renal disease with significant differences on prescription patterns (Figure 1A). Although it seems there is a numerical trend for increased undesirable clinical outcomes of ULT as CKD progresses, there are no statistical differences (Figure 1B) between the different groups. Stevens-Johnson Syndrome was reported in total of 4 patients. Conclusion: Patients with gout and advanced stages of CKD were less likely to receive ULT. ULT can be used in gout patients with CKD stage ≥ 3 without major unwanted clinical outcomes. REFERENCES: 1 Dalbeth N, House ME, Horne A, Taylor WJ. Reduced creatinine clearance is associated with early development of subcutaneous tophi in people with gout. BMC Musculoskelet Disord. 2013 Dec 21;14:363. doi: 10.1186/1471-2474-14-363. PMID: 24359261; PMCID: PMC3878111. 2 Kannuthurai V, Gaffo A. Management of Patients with Gout and Kidney Disease: A Review of Available Therapies and Common Missteps. Kidney360. 2023 Sep 1;4(9):e1332-e1340. doi: 10.34067/KID.0000000000000221. PMID: 37526648; PMCID: PMC10550007. 3 University of Mississippi Medical Center, Center for Informatics and Analytics (2020): Patient Cohort Explorer. figshare. Software. https://doi.org/10.6084/m9.figshare.12252737. Acknowledgements: NIL. Disclosure of Interests: None declared.