For Kidneys Sake
For Kidneys' Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)
This podcast series aims to provide healthcare professionals, particularly primary care professionals, with accessible insights into kidney health.
Each episode offers bite-sized discussions on key topics such as chronic kidney disease management and heart failure and practical updates for improving patient care. With episodes just 15 minutes long, you can listen on your commute, during a break, or while out for a walk. Join us as we explore the latest advancements and strategies in integrated kidney care to empower clinicians and patients alike.
For Kidneys Sake
For Gout’s Sake! Managing Gout in CKD
The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS).
In this episode of For Kidneys Sake, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel discuss the relationship between gout and chronic kidney disease (CKD). They explore how CKD increases the risk of developing gout due to impaired uric acid excretion and sometimes the effects of commonly prescribed medications such as diuretics. The conversation demystifies the clinical presentation of gout in CKD patients and clarifies that the diagnosis remains unchanged; it’s typically a clinical judgement, supported by elevated uric acid levels.
Most importantly, the episode offers a detailed and practical discussion on managing acute gout attacks in CKD patients, covering the nuanced use of NSAIDs, colchicine, and steroids depending on the severity of kidney impairment. The hosts also stress the importance of lifestyle modifications, including dietary changes and exercise, as well as when and how to initiate preventative treatments like allopurinol or febuxostat. With a tone that balances clinical depth and approachability, Jeremy and Andrew provide valuable guidance for GPs, pharmacists, and healthcare professionals managing these intersecting conditions.
Key Takeaways:
1. Gout is more common in people with CKD due to reduced uric acid excretion and side effects of common medications.
2. Diagnosis of gout in CKD patients remains clinical and mirrors that in the general population.
3. NSAIDs can be used cautiously in early CKD (GFR >45) for short durations, but not repeatedly; colchicine and steroids are alternatives, and for more advanced stages of CKD.
4. Lifestyle changes – especially diet and exercise – play a vital role in reducing gout attacks.
5. Allopurinol should be started at 100mg in CKD and titrated based on uric acid levels, with febuxostat as a second-line option.
Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE
Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)
The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.
The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.
Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub
