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Serum Uric Acid Monitoring Suboptimal Among Older Adults With Gout – Renal and Urology News

Although monitoring of serum uric acid levels is essential for titrating urate-lowering therapy to meet target levels, a recent study finds suboptimal testing of older adults with gout initiating treatment.

Noting that gout burden increases with age, investigators studied testing rates after initiation of urate-lowering therapy among 44,438 Canadian patients aged 66 years and older with gout who had universal health care. Of the cohort, 28,473 (64.1%) had serum uric testing within 6 months and 15,965 (35.9%) did not.

Family physicians and internists managed more than 80% of patients, and rheumatologists, nephrologists, and other specialists cared for the rest. Serum uric acid testing was consistently highest among rheumatologists, followed by nephrologists.


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Compared with rheumatologists, nephrologists had significant 63% decreased odds of testing serum uric acid within 6 months, Timothy S. H. Kwok, MD, MSc, of the University of Toronto in Ontario, Canada, and colleagues reported in Arthritis Care & Research. Internists, family physicians, and other specialties had 66%, 74%, and 75% decreased odds of testing, respectively. Male physicians had 13% decreased odds of testing compared with female physicians.

Patients with nondialysis-dependent chronic kidney disease, diabetes, and hypertension had significant 40%, 17%, and 11% increased odds of testing within 6 months, respectively, compared with the absence of these specific comorbidities, the investigators reported. Patients with end-stage kidney disease were excluded from the study. Older adults prescribed colchicine or oral corticosteroids within 2 weeks of urate-lowering therapy (presumably for gout flare) had significant 31% increased odds of timely testing, compared with patients without coprescription.

Patients with chronic obstructive pulmonary disease or a prior cardiovascular event had lower odds of testing, as did those residing in rural areas or with lower socioeconomic status.

The rate of 6-month serum uric acid testing in Ontario, Canada did increase over time, from 56.4% in 2010 to 71.3% in 2019, the investigators reported.

Whether close monitoring translated to urate-lowering therapy dose titration in line with a recommended treat-to-target approach is unknown, Dr Kwok’s team pointed out. Notably, patients who started at low allopurinol starting doses of 50 mg or less daily were more likely to have serum urate monitoring.

The investigators could not assess adherence to urate-lowering therapy or gout flare severity.

“A need exists to further study the causal mechanisms behind which factors ultimately influence SUA testing and to pinpoint tangible areas for improvement.”

Reference

Kwok TSH, Kuriya B, Hawker G, Li P, Choy G, Widdifield J. Serum urate monitoring among older adults with gout: initiating urate-lowering therapy in Ontario, Canada. Arthritis Care Res. doi:10.1002/acr.25167