What is your approach for gout flare prophylaxis in patients with diabetes and advanced CKD?

Flare prophylaxis is an essential component of gout management when initiating treatment with uric acid lowering drugs (ULD). It is proven that with initiation of uric acid lowering therapy will induce gout flares, much to the chagrin of patients and doctors alike. Further that flare prophylaxis with colchicine markedly diminishes that risk. My practice has been to initiate such flare prophylaxis 1-2 weeks before beginning ULD and the drug of choice is colchicine. For break-through flares, an extra 2 tabs taken stat followed by 1 an hour later gives the patient a handy tool to keep things under control.

When a patient has advanced renal insufficiency, defined as a creatinine clearance or eGFR <30, the risk of colchicine therapy dramatically ...