Contributed by Dr Loh Ping Tyug, Medical Director, Fajar Dialysis Centre, Diaverum.
Dennis¹, a 37-year-old fitness instructor, was diagnosed with gout three years ago after experiencing debilitating pains in his left foot seemingly out of nowhere. He had initially ignored the pains thinking it might have been caused by injury sustained during a workout.
However, one evening the pain became so intense that he finally saw his General Practitioner (GP) for pain medication. Surprised at the diagnosis, Dennis was told to monitor for potential triggers. Eventually, realising that red meat and alcohol were the usual culprits before a bad flare up.
Dennis’ GP also advised him to go for a full health checkup to ensure his kidneys were functioning well. Regular checkups thereafter were also recommended.
This may be surprising to many individuals for two reasons:
- Dennis is a young healthy man, who is active and not overweight
- Gout is not a condition that many associate with Chronic Kidney Disease (CKD)
Gout can be both a risk factor and symptom of CKD
Dennis’ story is not all that uncommon. Fortunately, he is an example of an individual who sought medical advice early, and has since been actively managing his health with the close support of his family doctor.
This, however, is not always the case, as awareness of lesser-known risk factors such as gout is still not prevalent enough and a major hurdle for the success of preventive measures.
Diabetes and high blood pressure are the two most common causes of CKD, and the public is generally aware of the correlation. In fact, I have often heard diabetes and CKD used interchangeably when speaking to patients and their families.
A 2022 study found that one out of 10 people with chronic kidney disease have gout, and an even higher percentage of people with gout have kidney disease.
The correlation between gout and CKD is due to the high concentration of uric acid in the blood, which can build up and form urate crystals as your blood is filtered through the kidneys. When passing through the kidneys, these crystals can cause inflammation, oxidative damage and scarring of kidneys. Left untreated, this damage may lead to kidney disease and failure.
On the other hand, patients with CKD have compromised kidney function and therefore can’t clear uric acid well – which also leads to gout.
In reaching for medication to manage inflammation and pain associated with gout, non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors – commonly prescribed for gout – can also lead to kidney disease over time.
Co-management between patient and doctor is key
Despite the rising prevalence and incidence of gout, suboptimal management of gout continues in many countries. In an information age, there is still a profound lack of awareness of the association between gout and CKD. This is where awareness for early action is essential, from both the patient and healthcare providers.
Firstly, patients with gout must review their food intake and lifestyle habits to make the necessary changes. This applies to individuals of all ages and fitness levels, even those like Dennis, who may appear perfectly healthy on the exterior.
In Dennis’ case, it was found that he was eating extremely high volumes of protein to build muscle, which is likely one of the reasons for his gout. Working together with his family physician to change his eating habits has helped to manage his condition.
In general, patients with gout need to limit purine-rich foods, such as meats, sugary foods and drinks. It is often the combination of this dietary indiscretion that triggers a gout attack. As an alternative, they can consume proteins such as chicken and eggs instead. I also recommend that my patients drink more water and avoid alcohol.
Secondly, patients with gout should also be mindful to adhere to uric acid lowering medication to prevent kidney disease. This is essential if you are still having frequent gout attacks despite your best efforts at lifestyle modifications.
Prioritising prevention and early detection
Dennis’s story reminds us of the critical role preventive care and early detection play in managing gout and preventing its potential link to CKD. By taking proactive measures, individuals with gout can significantly reduce their risk of developing CKD and its associated complications.
Timely intervention and close collaboration between patients and healthcare providers empower individuals to take control of their health, ensuring a better quality of life and long-term well-being.
Ultimately, neither gout nor a CKD diagnosis is a death sentence, and both conditions can be managed effectively for a better quality of life through a strong partnership between patient and healthcare provider.
About Dr Loh
Dr Loh Ping Tyug is the Medical Director of Diaverum’s Fajar, Farrer Park and Tampines Dialysis Centres. She also runs her own clinic, Kidney Life Centre.
She is an experienced Renal Physician with a keen interest in Glomerular Diseases and Diabetic Kidney Disease. Prior to private practice, Dr. Loh was a Senior Consultant Nephrologist at National University Hospital (NUH) in Singapore where she was the Director of Preventive Nephrology, working closely with Family Physicians in early detection and management of kidney diseases; and led the Glomerular Disease Management Clinic.
Find out more at: https://sg.diaverum.com/sg/en/home
¹ Not his real name
Images: Diaverum and Envato