UNDERSTANDINGUnderstanding GOUT ANDYour YOUR KIDNEYS Hemodialysis Access Options UNDERSTANDING GOUT AND YOUR KIDNEYS WHAT IS GOUT? Gout happens if a substance called uric acid gets too high in your blood. Gout is a common form of arthritis. Everyone has small amounts of uric It can cause pain, swelling, and acid in their blood. It comes from redness in your joints. Gout usually two places—the normal breakdown begins in the big toe, but can strike of your body’s cells and certain other joints such as the ankle, knee, foods. At normal levels, uric acid wrist, fingers, or elbow. Usually does not cause any damage. But if only one joint is affected, but some the levels get too high, it can form people may have gout in more than sharp crystals that build up in your one joint, especially if it is not found body’s joints and cause pain. The and treated. medical term for high blood urate levels is hyperuricemia. DID YOU KNOW? • About 8.3 million U.S. adults HOW DOES URIC ACID (3.9 percent) are living with CAUSE GOUT? gout today and up to 10% of people worldwide may have Whenever you eat or drink gout. Gout is the most common something, your body pulls out the form of arthritis. good stuff like vitamins, and gets rid of the waste. One of those • Gout puts you at risk for kidney waste products is uric acid. It is disease. Up to 20% percent of made when your body breaks down people with gout have mild to purines, which is found in certain moderate kidney disease. foods. Uric acid also comes from the • Having kidney disease puts you natural breakdown of cells. When at risk for gout. It is the third cells in your body die, they release most common risk factor for purines. gout. Healthy kidneys are filters. They • A recent study found that 64% remove uric acid and other waste of kidney patients with gout products from your blood. The were not being treated for it waste products leave your body and about 80% of these patients through urine. However, if more had uncontrolled gout. uric acid is made than the kidneys can remove, high uric acid levels WHAT CAUSES GOUT? can happen. If too much builds up, it can turn into crystals that settle in American Association of Kidney Patients: Understanding Gout and Your Kidneys 3 your joints. This can cause a gout the most reliable test for gout attack. and is considered the gold standard. • Blood test. A blood sample WHAT ARE THE SYMPTOMS is taken to see how much OF GOUT? uric acid is in your blood, A gout attack can happen without although high levels don’t warning. Most often, pain begins always mean gout. Some suddenly in one or more joints, people can have high levels usually at night. Often the joint in their blood and never get swells, feels warm, becomes painful, gout. and the skin over the joint may look • Imaging tests. X-rays, red, tight, and shiny. Pain and ultrasound, CT scans can also swelling usually peaks within 12 to be helpful in some people. 24 hours, and gets better within a X-rays are used to rule out few days to several weeks. other causes of joint swelling. The good news? Treatment can help Ultrasound and CT scans are shorten a gout attack and ease pain. used to look for urate crystals The earlier treatment is started, the in a joint. better. Gout attacks are also called flare-ups. IS GOUT SERIOUS? Gout is a serious disease that needs HOW DO I KNOW I HAVE to be found and treated. Without treatment, over time, gout attacks GOUT? (also called flare-ups) become If you have symptoms, talk to more painful and happen more your healthcare provider. Your often. Another problem? Swollen healthcare provider will give growths (called tophi) can form you a physical exam, ask about in the joints, under the skin, in your symptoms, and explore your bones or cartilage, or in the fluid- medical history. You may be given filled sacs that cushion the body’s some tests: tissue (called bursae). Tophi are not usually painful, but they can • Joint fluid test. A needle become inflamed and cause other is used to take fluid from a problems. As gout progresses, it can joint. The fluid is looked at destroy joints forever; limiting your under a microscope to see if it ability to move and affecting your has uric acid crystals. This is ability to do normal, day-to-day American Association of Kidney Patients: Understanding Gout and Your Kidneys 4 activities. Gout can also lead to loss • ACR (albumin-to-creatinine of kidney function. ratio) is a urine test that shows if protein (albumin) levels are too high, which may mean HOW DOES GOUT HURT kidney damage. MY KIDNEYS? Uric acid usually affects joints like WHO IS AT RISK FOR the big toe, but crystals can also form in your kidneys or in the tubes GOUT? that carry urine from your body. It is not fully known why some Kidney stones can develop and hurt people are more likely to get gout, the kidneys by: but some things can increase your • Blocking the kidneys from risk. removing waste products, • Gender and age. Gout is which can cause infection more common in men than • Scarring the kidneys with women up to age 60. In men, their sharp edges it usually happens between the ages of 30 and 45. In This can lead to kidney disease women, it usually happens or kidney failure. There is also after menopause. evidence that high uric acid levels alone can hurt your kidneys, aside • Family background. You from the damage caused by kidney are more likely to get gout stones. if other members of your family have it. • Lifestyle. Being overweight SHOULD I BE TESTED FOR and drinking too much KIDNEY DISEASE? alcohol can put you at risk for gout, especially drinking Yes. Gout puts you at risk for kidney beer, whiskey, gin, vodka, or disease and kidney failure. Ask your rum. The more alcohol you healthcare professional for these drink, the higher your risk. two simple tests: • Diet. Drinking sugary drinks • GFR (glomerular filtration or eating too much red meat, rate) is a blood test that checks organ meat, and some types how well your kidneys are of seafood can put you at filtering waste products from risk. your blood. American Association of Kidney Patients: Understanding Gout and Your Kidneys 5 • Medicine. You may have cause higher levels of uric a higher risk if you take acid in the blood. These certain medicines, such as include kidney disease, water pills (called diuretics), kidney failure, high blood low-dose aspirin, and some pressure, diabetes, and other anti-rejection drugs used disorders. by people who have had a kidney transplant or other organ transplant. IS MY RISK FOR GOUT • Recent surgery or trauma. HIGHER IF I HAVE KIDNEY Surgery, radiation therapy, or DISEASE? a sudden, severe illness can trigger a gout attack. Yes. Your kidneys do many important jobs that keep you • Other health problems. healthy. Among other things, they Certain health problems can balance your body’s fluids, help 6 American Association of Kidney Patients: Understanding Gout and Your Kidneys make red blood cells, and clean waste products from your blood. When you have kidney disease, it means your kidneys are damaged. They cannot do these jobs well. They cannot remove enough waste products like uric acid from your blood. As a result, your uric acid levels can get too high, and gout can happen. not be enough to control gout. CAN GOUT BE TREATED? Most people will need special Gout is a serious disease, but it can medicine to: be treated. Over time, treatment - Reduce pain during a gout will help gout flares be less painful, attack happen less often, and even stop coming back (called remission). - Lower the level of uric Treatment usually involves: acid over time and help keep future attacks from • Keeping serum urate levels happening in check. Having your serum urate levels checked regularly There is no single treatment that is is very important. Most right for everyone. Your treatment people with gout need to choices will depend on many things, keep uric acid levels under including how well your kidneys 6 mg/dL. Some people with work and whether you have other severe gout or tophi may health problems. need to keep uric acid levels even lower—under 5 mg/dL. • A healthy lifestyle. This IF I HAVE KIDNEY may include regular exercise, FAILURE, WILL MY losing weight, limiting purine-rich foods such as red DIALYSIS TREATMENT meat and shellfish, avoiding CONTROL GOUT? alcohol and sugary drinks, Dialysis is a process that filters and not smoking. (cleans) your blood when your • Taking medicine. A healthy kidneys no longer do this well. It is lifestyle is important, but may one of the basic forms of treatment American Association of Kidney Patients: Understanding Gout and Your Kidneys 7 for kidney failure. Dialysis cleans naproxen. NSAIDS can make waste products like uric acid from your kidney disease worse, so your blood, but usually cannot people with kidney disease or remove enough to stop gout. Most kidney failure should not take people on dialysis with gout still them without consulting their need special medicine to keep uric healthcare provider. acid levels in check. Medicine to keep future attacks from happening includes: WHICH MEDICINES ARE • Allopurinol and Febuxostat are considered “first-choice” USED TO TREAT GOUT? medicines. Both pills work Medicine to reduce pain during a by helping to block uric acid gout attack includes: from being produced.