Table 4

Treatment of crystal arthropathies in chronic kidney disease and dialysis patients

Drug

CKD stage 3 and stage 4 patients (GFR 15 to 59 ml/minute/1.73 m2)

Dialysis patients (GFR <15 ml/minute/1.73 m2)


Pain control in acute gout attack

NSAIDs

Avoid when possible or use with great caution

May be used with caution

Colchicine

Avoid when possible or use with great caution (for example, 0.5 mg three times per week)

Avoid whenever possible

Glucocorticoids

Short-term use possible (for example, 20 mg/day)

Short-term use possible (for example, 20 mg/day)

Anakinra

Effective (100 mg/day for 3 days) but yet limited data published

Not evaluated

Maintenance therapy

Allopurinol

Reduce dose to 100 to 150 mg or avoid

Avoid

Colchicine

Avoid when possible or use with great caution (for example, 0.5 mg three times per week)

Avoid whenever possible

Anakinra

Not evaluated

Effective in case reports (100 mg three times per week)

Febuxostat

Safe at GFR >30 ml/minute/1.73 m2

Not evaluated

Benzbromarone

Probably ineffective at GFR <50 ml/minute

Ineffective


CKD, chronic kidney disease; GFR, glomerular filtration rate; NSAID, nonsteroidal anti-inflammatory drug.

Anders and Vielhauer Arthritis Research & Therapy 2011 13:222   doi:10.1186/ar3256