Credit: Original article published here.Kidney transplant recipients with gout and hyperuricemia face increased risks for adverse outcomes. Results of the PROTECT study demonstrated that pegloticase lowered serum urate in 89% of kidney transplant recipients with uncontrolled gout. During a poster session at the National Kidney Foundation Spring Clinical Meetings 2023, Nicola Dalbeth, MBChB, MD, and colleagues reported associated changes in monosodium urate deposition volume (Vmsu) as seen on dual-energy computed tomography (DECT). The poster was titled Monosodium Urate Crystal Depletion in Renal Transplant Recipients Treated With Pegloticase: PROTECT Serial Dual-Energy Computed Tomography Findings. Inclusion criteria were uncontrolled gout (serum urate, ≥7 mg/dL; oral urate-lowering therapy refractory/intolerant; and ≥2 flares/year, ≥1 tophi, or chronic gouty arthritis), kidney transplant >1 year prior, graft estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m2, and stable immunosuppression. All patients received ≤24 weeks of pegloticase (8 mg biweekly; serum urate response, <6 mg/dL for ≥80% of month 6). DECT imaging was measured with standard protocols at screening (Scr). Vmsu was measured at weeks 14 and 24 with default postprocessing settings. Joints with Scr and week 24 images and Scr Vmsu ≥0.5 cm3 were included. The Vmsu criterion reduced the effects of DECT artifact. Eight patients underwent

Credit: Original article published here.Patients with advanced chronic kidney disease (CKD) commonly experience gout, a condition associated with CKD progression. In patients with CKD and uncontrolled gout, pegloticase lowers serum urate. Results of the MIRROR randomized, controlled trial demonstrated a higher response rate with methotrexate (MTX) versus placebo cotherapy (71.09% vs 38.5%). However, according to Abdul Abdellatif, MD, and colleagues, use of MTX had been limited due to the potential risk for an adverse impact on estimated glomerular filtration rate (eGFR) in patients with CKD. During a poster session at the National Kidney Foundation Spring Clinical Meetings 2023, Dr. Abdellatif et al reported 12-month changes in eGFR among patients in the MIRROR trial. The poster was titled eGFR Changes During Pegloticase Treatment With and Without Methotrexate Cotherapy: 12-Month Findings of MIRROR RCT. Uncontrolled gout was defined as serum urate ≥7 mg/dL, urate-lowering therapy failure/intolerance, and one or more gout symptoms. Patients with uncontrolled gout were randomized 2:1 to receive oral MTX (15 mg/week) or placebo as cotherapy to pegloticase (8 mg biweekly, 52 weeks). Patients with eGFR <40 mL/min/1.73 m2 were excluded. Following a 2-week MTX tolerance test and 4-week blinded MTX/placebo run-in period, patients began treatment with pegloticase plus