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Abstract: FR-PO217

Association of Renal Dysfunction and Development of Tophi in Subjects with Chronic Refractory Gout

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Johnson, Richard J., University of Colorado Denver , Aurora, Colorado, United States
  • Edwards, N. Lawrence, University of Florida College of Medicine, Gainesville, Florida, United States
  • Pillinger, Michael, NYU School of Medicine, New York, New York, United States
  • Yeo, Anthony, Horizon Pharma, Lake Forest, Illinois, United States
  • Lipsky, Peter E., AMPEL BioSolutions, Charlottesville, Virginia, United States

Many, but not all patients with chronic gout develop tophi, and the factors that govern tophus formation are not fully understood. Several studies have suggested impairment of renal function increases the risk for development of tophi, but others have not.


This analysis addressed the relationship between estimated glomerular filtration rate (eGFR) and the presence of tophi in patients with chronic refractory gout, as well as effects of tophus resolution on eGFR using results from two randomized controlled trials of pegloticase in chronic gout patients.


Overall, 73% of the 212 subjects in these trials had clinically apparent tophi at baseline and 27% did not. Subjects with tophi were significantly older than those without tophi (56.7 vs 51.9 years, P=0.034) and had a significantly longer disease duration (16.3 vs 11.7 years, P=0.0072). Subjects with tophi also had a significantly lower eGFR than those without tophi (59.8 vs 67.9 mL/min/1.73 m2, P=0.0495). Subjects with advanced renal disease were also more likely to have tophi. Persistent serum urate lowering and resolution of tophi in subjects treated with pegloticase had no significant effect on eGFR despite a significant decrease in the urinary uric acid:creatinine ratio.


These results indicate that chronic refractory gout patients may present with or without clinically apparent tophi and that there is a significant association between the presence of renal dysfunction measured by eGFR and the frequency with which chronic refractory gout patients manifested tophi. However, persistent serum urate lowering and tophus resolution had no significant effect on eGFR over the period of observation in this group of subjects.


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