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Recognizing the Need for Dual Treatment in Patients With Gout, CKD and the Role of the Nephrologist

October 27, 2020

By: Dr. Bradley Marder, Medical Director at Horizon Therapeutics

marderStarting Out  

My desire to make a positive impact on people’s lives led me to become a doctor. I trained as a nephrologist in New York and ultimately joined a nephrology practice in Denver. Treating patients with chronic kidney disease and kidney transplants was my primary focus for 17 years.  

During the nearly two decades as a practicing physician, I saw the full range of typical kidney patients, but one of the unexpected parts of patient care at my kidney transplant clinic was seeing many patients with gout—an inflammatory form of arthritis. Often it can be well controlled by daily oral medications but other times, the condition persists despite use of standard therapy. This uncontrolled form of gout causes worsening chronic pain and deposits of uric acid crystals call tophi.  

Like many nephrologists, at the time, I didn’t know how concerning uncontrolled gout was for my patients. It isn’t something nephrologists commonly manage and, as such, aren’t aware of the damage that uric acid can cause in the body outside of just the joints. What I’ve learned is that uric acid can deposit in nearly every tissue of the body, including the kidneys and the arteries. If a patient’s kidneys aren’t fulfilling their role to excrete enough uric acid—the buildup of which causes inflammation—the accumulation of urate crystals can contribute to the progression of chronic kidney disease and other comorbid conditions, like hypertension and cardiovascular disease.

As I continued to better understand gout, I found myself wanting to share this knowledge with my peers, especially given gout affects so many patients within nephrology practices. As I became involved in research regarding the management of uncontrolled gout, I became even more passionate about improving the lives of people suffering from gout and concomitant kidney disease. 

Recognizing the Potential to Make a System-Wide Impact

The more involved I became in managing my patients’ uncontrolled gout, the more rewarding my medical practice became. I was having a direct impact on something that was more often than not overlooked, and that affected the daily lives of my patients. While it was incredibly gratifying to help improve the lives of individual patients, I started to realize I wanted to do more, to help more patients on a greater scale. When the opportunity arose to join Horizon as a medical director, I knew it meant that I could be in on the ground floor to address important unmet needs in the gout disease space, especially as it relates to nephrology. I saw in Horizon the same commitment I also felt to expand the understanding of treatment options for patients with uncontrolled gout.

Importance of Educating Nephrologists About Gout

While not every person who has gout needs to be treated by a nephrologist, it is critical that patients who have kidney disease and gout be treated for both conditions. If a patient with gout also has chronic kidney disease, their primary care doctor may not recognize some important challenges to treating both conditions together. Certain medications may be contraindicated or require dosing adjustments for a patient with chronic kidney disease, for example. For many cases, nephrologists have the opportunity to play a more central role in managing their patient’s gout and provide the nuanced support needed due to their chronic kidney disease.  

In order to achieve the best patient outcomes, nephrologists need to be aware that gout is not just intermittent joint pain, but a progressive and systemic deposition of uric acid crystals in many body tissues—and treat it as such. Many are not fully aware of gout’s inextricable link to chronic kidney disease or the implications of chronic widespread urate deposition and the inflammatory reaction it produces. Though there are treatments that can address the uric acid buildup, without a complete understanding of the systemic nature of gout, the urgency to treat serum uric acid levels to below 6 mg/dl remains low.

Why My Experience Is Important for Health Care Workers 

Unfortunately, today, gout does not get the same kind of attention and care from health teams that other systemic health issues do—such as diabetes. In my time in clinical practice, I could help patients one at a time. When I joined Horizon’s medical affairs team, my ability to impact change shifted to so many more patients. I never would have guessed a condition that I once thought so difficult to manage would become such a big part of my life—that I would wake up each morning to help navigate the complex relationship between gout and the kidney and ultimately transform the lives of patients across the country. My days are spent in research and in educating other health care professionals, especially my fellow nephrologists, on the systemic nature of gout and its impact beyond the joints—even now it still feels new and different, but I love it. 

I hope that by sharing my journey, nephrologists will be encouraged to take a leading role in the diagnosis and management of gout to help their patients overcome the burden of this painful and destructive disease.  

About Dr. Bradley Marder:

Bradley Marder M.D. is the medical director of nephrology in medical affairs at Horizon Therapeutics. Since completing a nephrology fellowship at Icahn School of Medicine at Mount Sinai in New York, he has served as the director of clinical research and the principal investigator in multiple clinical trials on treatments for kidney transplant patients and those with chronic kidney disease, authoring numerous publications dedicated to bringing innovative therapies to patients in need.

Prior to joining the leadership ranks at Horizon, Dr. Marder worked as a transplant physician and medical director for Presbyterian/St. Luke’s Transplant Center and as chairman of the department of medicine for Presbyterian/St. Luke’s Medical Center in Denver. He has served in multiple hospital committees and as an advisor for Donor Alliance, Colorado’s organ procurement organization.

Dr. Marder earned his bachelor’s degree in molecular biology from the University of California, Berkeley, and his doctor of medicine from the Sackler School of Medicine at Tel Aviv University, after which he completed an internship and residency in internal medicine at the Montefiore Medical Center of the Albert Einstein College of Medicine in New York.

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