Gout and Its Link to Chronic Kidney Disease

3 min read

Reviewed by: HU Medical Review Board | Last reviewed: February 2023

Though chronic kidney disease (CKD) mainly affects the kidneys, it also can affect many other parts of the body. If you are living with CKD, it is important to be aware of the health problems that can occur with it (called complications). That way, you can be on the lookout for signs of these complications. One common complication of CKD is gout.¹

What is gout?

Gout is an “inflammatory arthropathy,” meaning a joint disease caused by inflammation. It occurs when uric acid builds up in your body.^1,2

Uric acid is a normal substance that your body creates as it breaks down proteins. There are two ways that uric acid can build up. One way is when your body makes too much uric acid. The other way is when your kidneys cannot filter enough uric acid out of the blood to get rid of it in pee (urine).²

In either case, uric acid can build up in joints, causing redness, swelling, and sharp pain at the joint. Gout commonly affects the joints in your big toes. This is called podagra. However, it can also build up in other joints, like your knees, or create kidney stones.^1,2

Who gets gout?

Experts estimate that about 4 percent of the US population has gout. Men are about 3 times more likely to develop gout than women.¹

Those who are living with CKD also are more likely to develop gout than those who are not. As the number of people living with CKD increases, so does the number of people living with gout. However, it is possible to develop gout without CKD.¹

The main risk factors for developing gout include:¹

Having high levels of uric acid in your blood
Being male
Being age 65 or older
Being post-menopausal

The main risk factors for developing CKD include:¹

Having diabetes
Having high blood pressure
Having family members with kidney disease
Being of African American, Hispanic, Pacific Islander, or American Indian descent

How are CKD and gout linked?

The relationship between CKD and gout works in both directions. In one direction, CKD can cause gout by making it difficult to get rid of uric acid.^2,3

When your body creates uric acid, it pushes it into the bloodstream. Your blood then flows through your kidneys, which remove the uric acid and add it to urine to leave the body. With CKD, your kidneys are not able to filter your blood as well as they should. This leads to a buildup of substances like uric acid. High levels of uric acid, or hyperuricemia, can then deposit in joints and appear as gout.^2,3

In the other direction, gout can cause kidney damage. Having high levels of uric acid can damage your kidneys. Uric acid can also form into sharp kidney stones inside a kidney that can cause damage as they are being passed. A 2019 study found that people with gout were more than twice as likely to develop kidney failure than those without gout.³

Diet changes to manage gout

If you have gout, one way to reduce your likelihood of flares is by changing your diet. There are some foods that have high levels of “purines.” Purines are broken down by the body into uric acid. Foods to avoid or limit include:²

Organ meats
Shellfish
Beer
High-fructose corn syrup

Reducing all meats and adding in more plant-based meals also may help. Everyone should eat fruits and vegetables often as well as drink enough water to stay hydrated. Good hydration helps the kidneys do their job to filter the blood.²

Talking to your doctor about CKD and gout

CKD and gout often occur together. If you are currently living with one of these conditions, talk to your doctor about your risk of developing the other. They can give you an idea of signs or symptoms to look out for. They also can order blood work to check your kidney function and uric acid levels.¹

Experts used to believe that gout was only present during its painful attacks. Because of this, doctors often prescribed drugs only to stop the attack. But experts now understand that gout is a chronic disease. It will progress if it is not treated. Speak to your doctor about the right gout treatment for you.¹

Join the conversation

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Cinders Member
Regarding Gout…Tart Cherry Juice not from concentrate is really good for balancing out the Uric Acid and helping to keep gout away. I drink 8oz everyday. Also, try adding some lemon juice into your water like every other bottle. You don’t want to drink it in every water you have as that can be too much. 
1. Diane Talbert Moderator & Contributor
 Hello <inline-mention username="CommunityMember84a2a1" user-id="6899019"/>, Thanks for sharing that tip. I have a family member with gout who puts lemon in his water also and change his diet. How is your gout doing these days? Diane (Team Member)
2. Cinders Member
 My gout has been in check. Drinking the tart cherry juice which I buy
Cinders Member
Wow it didn’t post my whole long reply. Weird. 
1. minel-cannucciari Community Admin
 That's weird, sorry about the inconvenience, <inline-mention username="CommunityMember84a2a1" user-id="6899019"/>. If you remember what else you posted and feel like re-sharing, please feel free (though completely understand if it's too tedious). I'm glad to hear though that your gout has been in check and the tart cherry juice has been helping! Warmly, Minel (Team Member)
Cinders Member
This article has some good information in it but it doesn’t talk about what you can do to help reduce a gout flare up when you get one. Like I mentioned, Lemon water: A study has reported that lemon water or drinks high in vitamin C helps neutralize uric acid in the body. Squeezing two fresh lemons into two liters of water can help reduce uric acid levels in the body. Cherries have antioxidant and anti-inflammatory properties, so many people with gout may try drinking cherry juice to help treat their symptoms and prevent flare-ups. Purchase tart Cherry juice with as little sugar in it as possible and get the not from concentrate juice. Coffee. Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you. The thing is to stay away from the high purine foods and stick to low purine foods. Always check with your doctor about any of these especially if you have high potassium or phosphorus or diabetes or any other situation where eating any of these would have an adverse effect. Low-purine foods include: Certain fruits, like cherries, berries, and citrus fruits Nonfat and low-fat dairy (milk, cheese, yogurt) I use non-dairy Plant-based protein foods such as nuts, peanut butter, seeds, and legumes Eggs (in moderation because they are animal protein) Whole grain bread and pasta, rice (i use brown rice), potatoes (I hardly ever have potatoes) Vegetables Plant-Based Foods Many plant-based foods are low in purines, making them an excellent choice for a gout-friendly diet. They also contain numerous health-promoting nutrients, including vitamins, minerals, and fiber. Plant-based foods include: Beans and other legumes Fruit Nuts Nut and vegetable-based oils Seeds Soy-based proteins, such as tofu, tempeh, soy nuts, and soy milk Vegetables Whole grains Plant-based diets have been shown to decrease the risk of gout, according to two separate prospective cohort studies. Some vegetables are higher in purines. However, the body processes plant-based purines differently. Research shows that plant-based purines do not increase the risk of gout and may actually decrease risk. A 2019 review of plant-based diets and their association with gout suggested that reasonable consumption of higher purine plant foods as a part of a plant-based diet may be safely tolerated in healthy people. Researchers noted that additional studies are needed in people with high uric acid levels, especially those who suffer from chronic kidney disease. How to help with the pain. Urate Crystals - The key hypothesis is that these urate crystals dissolve on warming. Hence, by warming the joint concerned in hot water, and moving the joint around to encourage diffusion, the urate concentration is reduced and crystals no longer form, provided the treatment is continued. For those who have chronic Uric Acid you may need a prescription drug to go along with your diet. So far I have been able to control mine with my diet. Now, if I could just get my night time leg cramps to calm down I would be happy. I need to do more research. 
1. minel-cannucciari Community Admin
 Thanks for sharing <inline-mention username="CommunityMember84a2a1" user-id="6899019"/>! I hope you can find something that helps with the leg cramps. Warmly, Minel (Team Member)

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