ASN 2025 Kidney Week: Research Demonstrates Associations Between CKD and Gout

Research presented at the American Society of Nephrology (ASN) 2025 Kidney Week Annual Meeting held on November 5 through 9 suggests links between chronic kidney disease (CKD) and uncontrolled gout. The findings emphasize a need for future research, additional awareness among health care professionals, and treatment optimization and new therapies.^1,2 

What is Gout?

According to Mayo Clinic, gout is a common but complex form of arthritis that can affect anyone. It is characterized by sudden and severe attacks of pain, swelling, redness, and tenderness in one or more joints, most commonly the big toe. A gout attack can occur suddenly; oftentimes, patients with gout will experience a fire-like sensation in their big toe. The affected joint feels hot, swollen, and so tender that subtle weight—such as a bedsheet or sock—may feel intolerable.³

Gout may also affect the knees, elbows, wrists, ankles, and fingers, with the most severe pain occurring within the first 4 to 12 hours after onset. Even after severe pain subsides, patients will continue to experience joint discomfort, which can last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints, Mayo Clinic reports. Additionally, as gout progresses, patients may not be able to move their joints normally.³ Uncontrolled gout is a persistent form of gout with active symptoms (eg, gout flares, tophi, etc) and high serum uric acid levels (> 6 mg/dL) despite the use of oral urate-lowering therapies.¹

Abstract 1: Management of Uncontrolled Gout Among Nephrology Professionals

Patients with CKD have a 5-times higher prevalence of gout than those without. This study assessed current management and clinical presentation of uncontrolled gout in patients with CKD managed by nephrologists in the US. US board-certified nephrologists who had at least 3 years of clinical practice and 25 or more patients with gout (≥5 with uncontrolled gout) managed over the last year participated in a retrospective, web-enabled chart audit study from March to June 2024. Physicians provided perceptions of uncontrolled gout management and abstracted data from eligible patient charts, including those diagnosed with uncontrolled gout, those with gout-related symptoms over the last year, and those with serum uric acid greater than 6 mg/dL.¹

Seventy-five nephrologists abstracted 202 charts of patients with uncontrolled gout. The vast majority of patients (97%) were diagnosed with CKD, of which 31% had stage 3b. The mean age of patients at the time of gout diagnosis was 49 years. Other than CKD, the most common comorbidities were hypertension (48%), obesity (35%), and diabetes (32%). At the most recent visit, the mean serum uric acid was about 8.2 mg/dL, with patients experiencing visible tophi (87%), joint pain (43%), swollen joints (42%), and gout flares (32%).¹

The most recently administered oral urate-lowering therapies were allopurinol (Zyloprim; Casper Pharma; 60%), febuxostat (Uloric; Takeda Pharmaceuticals; 35%), colchicine (Colcrys; Takeda Pharmaceuticals; 18%), and pegloticase (Krystexxa; Amgen; 7%). Approximately 37% of those were considered adherent (taking medications over 75% of the time), with lack of compliance mainly attributed to forgetfulness (58%).¹

Throughout the year, about 27% of patients had gout-related emergency room visits, and 5% were hospitalized for a mean of 2 days. Most nephrologists (96%) believed patients were impacted by the burden of current gout treatments, and uncontrolled gout at least moderately impacted patients’ overall quality of life (98%), hobbies (90%), social life (85%–88%), and family life (83%). Regarding treatments, 93% of nephrologists expressed a need for treatments for patients with CKD and uncontrolled gout.¹

Abstract 2: Risk of New-Onset CKD, Kidney Failure, and Mortality in Patients with Uncontrolled Gout vs. Controlled Gout

This retrospective cohort study utilized Optum Clinformatics DataMart, which included data from 2016 to 2024. In this study, controlled gout was defined by no flares, no visible tophi during the baseline year, and normal SU levels (preindex serum urate < 6 mg/dL for 3 months). Patients who had any stage of CKD at baseline were excluded. Uncontrolled gout included patients with flares, tophi, or gout-related emergency department visits or hospitalizations with a preindex serum urate of 6 mg/dL or greater for a 3-month duration.²

Outcomes—which were analyzed separately—included incident renal failure (first occurrence of stage 5 CKD, dialysis, kidney transplant, or end-stage renal disease), incident CKD (estimated glomerular filtration rate [eGFR] < 60 ml/min), and all-cause mortality. The investigators estimated inverse-probability of treatment weights (IPTW) for each cohort using propensity scores. Cox proportional hazard models were used to generate hazard ratios (HRs).²

A total of 13,736 patients had uncontrolled gout in the CKD/renal failure outcome cohorts, and 21,292 in the mortality outcome cohort. Generally, uncontrolled gout cohorts were younger (54% vs 68%) but had more males (77% vs 61%) and comorbidities, such as obesity (24% vs 10%) and hypertension (63% vs 39%), compared with the controlled gout cohort. Further, the 3 outcome-specific cohorts shared similar baseline features.²

After IPTW weighting, uncontrolled gout compared with controlled gout was associated with a higher risk of new onset of renal failure (HR 3.5 [95% CI 3.2-3.7]; incidence rate: 77 vs 27 events/1000 person-years), CKD eGFR of 60 mL/min or less (HR 2.1 [95% CI 2.0-2.2]; 101 vs 58 events/1000 person-years), and a higher mortality (HR 1.5 [95% CI 1.4-1.6]; 60 vs 42 events/1000 person-years).²

The Pharmacist’s Role in CKD and Gout

Pharmacists play role when improving outcomes for patients with CKD and gout by optimizing therapy, monitoring safety, and addressing adherence barriers that contribute to uncontrolled disease. Because of the high prevalence of gout among patients with CKD and the elevated risks of renal failure, disease progression, and mortality associated with uncontrolled gout, pharmacists are uniquely positioned to guide appropriate urate-lowering therapy selection and dosing in the setting of impaired renal function. They can assess serum uric acid trends, evaluate comorbidities (eg, hypertension and diabetes), and identify patients who may benefit from therapy escalation or referral for advanced treatments.

Further, pharmacists can proactively address nonadherence by educating patients on medication synchronization and providing adherence tools, while also counseling on flare-up management and treatment-related adverse effects. Additionally, by collaborating closely with nephrologists and other health care providers, pharmacists help reduce preventable emergency visits and hospitalizations, improve quality of life, and support more comprehensive, patient-centered management of gout among patients with CKD.

REFERENCES

1. Desai B, Choi H, Kragh N, et al. Management of Uncontrolled Gout Among Nephrology Professionals: Findings from a Medical Chart Audit: TH-PO1079. J Am Soc Nephrol. 2025;36(10S):10.1681/ASN.2025hfh3tjt8. doi:10.1681/ASN.2025hfh3tjt8

2. Zhang T, Mende C, El-Meanawy A, et al. Risk of New-Onset CKD, Kidney Failure, and Mortality in Patients with Uncontrolled Gout vs. Controlled Gout: TH-PO1081. J Am Soc Nephrol. 2025;36(10S):10.1681/ASN.20254qbv8pkj. doi:10.1681/ASN.20254qbv8pkj

3. Mayo Clinic. Gout. Accessed December 15, 2025. https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897