Abstract: PUB575
GFR Recovery in a Patient with Stage 4 CKD and Chronic Uncontrolled Gout after Treatment with Intravenous (IV) Pegloticase
Session Information
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Rodriguez, Eddie M., Bayamon Medical Center, Bayamon, Puerto Rico
- Santiago Calderon, Sergio Fabian, Universidad Central de Bayamon, Bayamon, Puerto Rico
- Quintero Alvarez, Hector, Universidad Central de Bayamon, Bayamon, Puerto Rico
Introduction
Gout has been associated as an important comorbidity for cardiovascular disease, Diabetes Mellitus type 2, increase risk of death, and chronic kidney disease. Kidney biopsies have shown urate deposition in kidney tissue and there is a chronic inflammatory component that may be contributing to GFR loss in CKD patients with uncontrolled gout. But a correlating between chronic gout stabilization and renal protection outcomes has not been established, in part due to lack of effective therapies to significantly impact urate tissue in chronic uncontrolled gout.
Case Description
A 59 y/o male with past medical history of coronary artery disease, Diabetes Mellitus Type 2, chronic kidney disease stage 4 and uncontrolled Gout with Tophi and recurrent flares. Patient usually treated flares with prednisone and avoided colchicine and NSAIDS due to CKD status. Due to failure of conventional therapies of uric acid lowering therapy he was started on Pegloticase infusion IV every 2 weeks. After 6 months of treatment in addition of controlling flares and tophi dissolution he has shown a consistent improvement in eGFR which has increased after each visit. Initial eGFR prior initiation of treatment was 28 ml/min. After 6 months of treatment latest eGFR is 70 ml/min which shows dramatic improvement after stabilizing uncontrolled gout and the removal of the urate burden from tissues.
Discussion
Improvement of GFR with by controlling inflamation and reducing urate burden in CKD patient with chronic gout is a promising treatment alternative. At the moment Pegloticase is indicated for treatment of patients with uncontrolled gout regardless of GFR since it does not require dose adjustments related to GFR, but the indication is to reduce flares and tophi disolution. So far there is only anecdotal data that patients may present benefits in term of GFR recovery after treatment with Pegloticase. The findings of his case proposes that treatment with pegloticase IV could be beneficial for patients with uncontrolled gout in terms of eGFR recovery and also reduction in CKD progression by stabilizing chronic uncontrolled gout. Potentially this may leed to future controlled trials which may further evaluate pegloticase as a treatment for GFR recovery and GFR protection in patients with CKD and chronic gout.