Background/Purpose: To explore the number of patients on haemodialysis (HD) or peritoneal dialysis (PD) with gout in Canterbury and to determine how many were receiving urate lowering therapy (ULT) and achieving target serum urate (SU).

Methods: Individuals with gout in Canterbury receiving dialysis for at least 90 days on 1^st February 2017, 1^st January 2016 and 1^st January 2015 were identified. Pre-dialysis SU was recorded and SU levels for two days immediately post dialysis were estimated. These estimates were then used to estimate the percentage time serum urate was <0.36mmol/l using linear interpolation. Results were compared between those on ULT and not on ULT.

Results: 61/216 (28.8%) dialysis patients had gout.  Mean age was 61years (23- 84), 46/61 (75.4%) were male and 37/61 (60.7%) were European. 33/61 (54%) were receiving HD. 42/61 (68.9%) were receiving ULT, all allopurinol with a mean (SD) dose of 116.0 ± 66.9mg/d. A total of 936 pre-dialysis serum urate values were available from the 61 people with gout with a median (range) number of tests per participant of 15 (3-42). 46% of participants had a pre-dialysis SU <0.36mmol/l on less than 25% of occasions and 23% of participants were below target SU on 76-100% of occasions (Figure). There was no significant differences between those receiving HD and PD (median 35.3% vs. 20.0% p=0.39) and between those taking ULT and those not on ULT (median 34.5% vs. 27.8% p=0.55) in terms of % pre-dialysis urate below target (figure). The mean reduction in SU 24 and 48 hours post HD were 41% and 12% respectively as calculated from the previous study. The percentage time SU was below target two days post HD was only 41%, with no difference in those on or off ULT (43% vs 36%; p=0.55).

Conclusion: Gout is a common disease affecting 1/4 dialysis patients in Canterbury. The majority of our study patients were receiving ULT with allopurinol.  Dialysis alone is insufficient to lower SU and the use of ULT should be considered in those who remain above target SU using a treat to target SU approach.

Figure1: a) Percentage time at target in a) HD vs PD, b) on and off ULT and c) post HD