GOUTY-ARTHRITIS IN END-STAGE RENAL-DISEASE - CLINICAL COURSE AND RARITY OF NEW CASES

We studied 201 end-stage renal disease (ESRD) patients sustained on maintenance hemodialysis (MD) (n =164) and chronic ambulatory peritoneal dialysis (CAPD) (n = 37) to determine (1) the frequency of acute attacks of gouty arthritis (GA) in those ESRD patients who had GA before dialytic therapy, and (2) the incidence of new-onset GA in hyperuricemic long-term (〉12 years) ESRD patients on MD. The 2-month mean of predialysis serum uric acid levels was calculated for each subject and the prevalence of hyperuricemia ascertained. There were 25 patients on MD for more than 12 years, and this group was evaluated and analyzed separately from those patients on dialytic therapy for less than 12 years; the mean of each of their predialysis uric acid values was calculated for each subject for at least 60% of the time they have been on dialysis. Patients who had GA before or after initiation of dialytic therapy were identified, and the frequency of acute attacks of GA determined. The presence of treated hypertension in each subject was noted. Thirteen of 201 patients had clinically active GA before commencing dialytic therapy, and each recalled a minimum of two painful attacks of GA per year before the initiation of ESRD therapy. Mean duration of ESRD for these 13 patients was 25 ± 3.8 months; painful attacks of GA have not recurred in nine patients (70%), and the frequency of attacks declined by 50% in the remaining four patients (30%), despite persistent hyperuricemia in all 13. None of the patients studied, including those on MD for more than 12 years (mean, 16.3 ± 3.4 years; range, 12.5 to 26), developed new-onset clinical GA, even with sustained and severe hyperuricemia. We conclude that there is remarkable improvement in the clinical activity of GA in ESRD patients on CAPD and MD, and that new-onset GA is rare in hyperuricemic long-term ESRD patients. © 1994, National Kidney Foundation. All rights reserved. All rights reserved.