How do you use colchicine for gout in patients with chronic kidney disease or end-stage renal disease on hemodialysis?

As a last resort agent and with a lot of caution. For prophylaxis, half a 0.6 mg pill two times a week, carefully monitoring CBC and CK levels. If medication interactions are of concern, then do not use.

For flares, a much better alternative would be glucocorticoids or even anakinra. NSAIDs could be considered in those with no consideration of renal recovery, but still is a very unlikely alternative. Half a pill once (no repeat dosing) as soon as symptoms start. Would not use (unlikely to help) when flare symptoms have been present for more than 48 hours or more than one joint/joint area.

Agree with the reduction in dose according to GFR levels and a unique steroid shot.