Abstract
Background Gout commonly coexists with chronic kidney disease (CKD) due to reduced renal excretion of uric acid (UA). Guidelines recommend regular monitoring and dose adjustment of urate-lowering therapy (ULT), but the rate of adherence to these guidelines is not well established. Our study aimed to determine adherence to ULT guidelines in gout patients at our institution. In particular, we sought to assess the effect of CKD as well as other comorbidities on the prevalence of ULT guideline adherence. Methods We conducted a retrospective cohort study of 5,985 gout patients at our institution initiated on allopurinol between 2015 and 2020. Inclusion criteria were age over 18, a gout diagnosis, and a new allopurinol prescription. The primary outcome was UA monitoring within six months of therapy initiation. A secondary outcome was the prevalence of dose adjustments made by providers in response to a UA level above target. Results Only 48.3% (n = 2,889) of patients had UA levels monitored within six months. CKD stage did not significantly impact monitoring rates (p = 0.059). In patients with elevated UA levels (>6 mg/dL), 54.3% (n = 1,011) of patients had no dosage adjustments. Conclusions Significant gaps exist in adherence to ULT guidelines; nearly half of patients did not undergo recommended UA monitoring. Over half of patients with elevated uric levels did not have dosage adjustments. CKD stage did not affect the likelihood of UA monitoring or dose changes in persons with elevated UA levels.