According to the American Kidney Fund, one out of every ten people with kidney disease have gout. The number of people with gout that have kidney disease is unclear, yet we know that there is a higher risk factor for people with gout developing kidney stones and kidney disease.
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What is gout?
Gout is a type of arthritis that is inflammatory and very painful. It can be acute or chronic. Acute gout means only 1 joint is affected with flares whereas chronic gout includes multiple joints with repeated episodes of flares.
It’s important to know that just having a high uric acid level does not mean you have gout. In fact, most people that have high uric acid don’t get gout or kidney stones.
What causes gout?
Gout is caused by a buildup of uric acid. When a person develops high levels of uric acid in their blood, known as hyperuricemia, the urate crystals can collect and can then stick around the join areas.
Hyperuricemia does not always lead to symptoms or a diagnosis of gout. If high levels of uric acid are noted without symptoms, it may not need to be treated.
Uric acid is produced when the body breaks down purines. The kidneys are generally responsible for eliminating excessive uric acid from the body. This, however, does not always happen, especially in people with kidney disease.
Who is at risk for gout?
In general, gout is more common in men. Additional risk factors for gout include obesity, high blood pressure, congestive heart failure, insulin resistance or diabetes, or kidney disease.
If you have kidney disease, you are at a higher risk for developing gout due to the limited ability to remove the uric acid from your body.
Other risk factors for developing gout include using certain medications (such as water pills), drinking alcohol, or a diet high in sugar or purines.
What are the symptoms of gout?
Gout symptoms include sudden and severe jolts of pain, usually at the joints. It can feel hot, swollen and tender. A person experiencing a gout attack may also complain of limited mobility and movement.
How do I know if I have gout?
Gout can only be diagnosed during a flare. Your doctor can diagnose with an x-ray and lab tests. They will look for uric acid crystals in the inflamed joint.
Only a doctor can diagnose you with gout. You can look for a rheumatologist, which is a doctor that specializes in musculoskeletal disease and systemic autoimmune conditions.
Gout and Chronic Kidney Disease
While there seems to be a “two-way road” relationship between gout and CKD, it seems to be more heavily leaning towards CKD causing gout rather than gout causing CKD.
The kidneys are responsible for eliminating more than 70% of the uric acid in the body.
That being said, research has shown that even without symptoms of gout or kidney stones, having high levels of uric acid when you have kidney disease can increase the progression of kidney disease. So it’s important to be aware of your uric acid levels and talk with your doctor about how to best manage it.
Medications and Gout
One of the most common medications prescribed for gout is allopurinol. Newer research is now showing that a newer medication, febuxostat (Uloric for the brand name), is showing more promising results in lowering uric acid.
Whatever medication you are currently taking, it’s always very important to first discuss any changes with your primary care physician or nephrologist. They will be able to assess your case and determine what medication will be the best for you.
Is there a relationship between gout, kidney disease and kidney stones?
Uric acid stones are the second-most commonly formed kidney stones, behind calcium stones.
One study early in 2020 showed that in researching the prevalence of stones, 13.9% were caused by high uric acid levels. In the study, the ages of those with these stones were in their 30s up to the 60s.
A condition known as uric acid nephrolithiasis is when there is a low urine pH, low urine volume, that lead to uric acid stone formation.
Can you dissolve uric acid kidney stones?
Uric acid stones can be dissolved with potassium citrate, a medication prescribed by your urologist. (A urologist is someone who focuses on your urinary tract, including kidney stones.) If potassium balance is a concern, the doctor may order sodium bicarbonate to help with the urine pH.
Always take prescribed medications as directed by the prescribing physician.
If the stone cannot be dissolved with medicinal interventions, shock wave lithotripsy or surgical interventions may be needed.
Foods to avoid with gout
|Organ Meats||Liver, sweetbreads, kidney|
|Animal Meat||Beef, lamb, pork|
|Seafood||Tuna, sardines, shellfish, anchovies|
|Sugary foods and drinks with high fructose corn syrup||Sweetened foods like cereal, doughnuts, candies, chocolates, sodas|
Foods to have with gout
|Food Group/Category||Examples and details|
|Fruits||Evidence has shown that cherries (any type!) can help in reducing gout attacks.|
|Vegetables||While there are some high-purine vegetables, like asparagus and spinach, research has shown that moderate consumption of these don’t increase risk of gout attacks|
|Whole grains||Even whole grains that have purines have great benefits to help lower the risk of heart disease, stroke, and diabetes!|
|Heart-healthy Oils||Avocado oil, olive oil, flaxseed/flaxseed oil, chia seeds, hemp seeds|
|Nuts and Nut butters||Another healthy fat source! Peanuts have specifically been found to be in a diet that produced lower urate levels.|
|Low-fat or fat-free dairy products||Dairy has seen to have a protective factor in preventing gout attacks.|
|Lean meats in moderation||Keep animal protein choices to chicken, and some fish to about 4 to 6 ounces daily or per your dietitian’s guidelines.|
|Coffee||In moderation, coffee is shown to lower risk of gout. (And remember, you can have coffee with CKD!)|
|Wine||In moderation, wine has not been shown to increase risk of gout attacks|
Diet Considerations for Gout and Kidney Disease
While it seems like the diets may be conflicting between gout and kidney disease, they actually line up fairly similarly!
Focus on plant proteins
Animal proteins are higher in purines. Protein sources from plants may have some purines in them, but are often not seen as a factor in gout attacks. Plus the other nutrients that come from the plants (like fiber, vitamins and minerals) also help in lowering risks for other health concerns related to gout.
Eat a variety of fruits and vegetables
By eating more fruits and vegetables, you can help prevent your urine from becoming too acidic. Increase your urine pH by eating at least 2-3 servings of fruits and 3-5 servings of vegetables daily. Need to limit potassium? Stick to the low-potassium fruits and veggies to get in those servings!
Include health fats
We talked about how keto isn’t quite the right option for everyone with kidney disease, but a modified version can be great. Include good-for-you fats like avocado oil, nuts and seeds to prevent inflammation and get enough calories in.
Dairy in moderation
Dairy products – meaning from animals – tends to be higher in phosphorus and potassium. If you struggle in balancing these with your kidney diet, keep portions limited.
Hydrate with Gout
Drinking enough water is crucial to preventing hyperuricemia. Recommendations can start at 8 to 16 cups per day.
Vitamin C has been shown to be helpful with preventing gout flares. However, vitamin C supplements are something to be careful with if you have kidney issues as the kidneys are responsible for getting rid of any excess vitamin C.
We can get plenty of vitamin C in our diet with fruits and vegetables. If you’d like to add some more in an easy way, try squeezing some lemon juice to your water!
Be sure to check with your dietitian or doctor about how much water you should be drinking. If you have been advised to limit your fluids due to kidney disease, drinking above that will not help and could actually cause more problems.
While gout can be a painful diagnosis and situation, many of the factor involved in how often it happens are completely up to you!
By focusing on a diet rich in fruits and vegetables, low in animal meats, sugars, and alcohol, and of course staying well-hydrated, you will be able to help prevent gout flares from happening.
Doing these things can not only help prevent gout flares, but also protect against uric acid stones.