In chronic kidney disease, NSAIDs are best avoided. Colchicine can be used at reduced dose and frequency, with care over interacting drugs such as clarithromycin, and avoided in dialysis patients. Corticosteroids — oral, intramuscular or intra-articular for a single joint — are usually the most practical choice. Do not stop allopurinol during a flare in a patient already taking it.
- Avoid NSAIDs in moderate to severe CKD.
- If using colchicine in CKD, lower the dose and check for CYP3A4 and P-glycoprotein inhibitors.
- A short oral prednisolone course or an intra-articular injection suits most CKD patients.
- Continue urate-lowering therapy through a flare if already established.
Why it matters
Flares in CKD are often treated late or with drugs the kidneys cannot handle.
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