Inpatient Management of Gout: Serum Urate Testing and Allopurinol Dose Adjustment

Objective Despite effective treatment, gout is poorly managed. The aim of this study was to determine rates of serum urate (SU) testing and allopurinol dose adjustment in patients admitted to Christchurch-based hospitals who were receiving allopurinol.

Methods The hospital electronic prescribing and administration (ePA) system was used to identify patients receiving allopurinol during hospital admissions from March 2016 to March 2023. Demographics, SU, renal function, and changes to allopurinol therapy were recorded for each admission. Results were stratified by target SU and renal function.

Results Of 18,081 patients who received allopurinol, SU was measured in 2950 (16.32%). The mean SU was 0.37 (SD 0.12) mmol/L, with 1270 (43.05%) above target SU (0.36 mmol/L). Admissions with chronic kidney disease (CKD) stage 3-5 were more likely to have SU above target than those with CKD stage 1-2 (78.84% vs 21.26%; P < 0.001). Among those with SU above target, allopurinol was discontinued in 148 (11.65%) and the dose reduced in 44 (3.46%), increased in 92 (7.24%), and unchanged in 986 (77.63%) during the admission. Those above target SU with CKD stage 3-5 were more likely to stop or decrease allopurinol compared to those with CKD stage 1-2 (16.4% vs 10.4%; P = 0.01).

Conclusion More than 80% of hospital admissions did not have SU measured, despite the patient receiving allopurinol. Most admissions had suboptimal management of the allopurinol dose in the context of their SU. These results reflect a missed opportunity to review and optimize gout management.