Safety and Efficacy of Colchicine for the Treatment of Pericarditis in Patients with Chronic Kidney Disease

This retrospective multicenter cohort study compared the safety and efficacy of low- versus high-dose colchicine in adult patients with chronic kidney disease (CKD) treated for pericarditis between August 2015 and August 2024. CKD was identified using ICD codes and confirmed by an age- and sex-adjusted estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m ² . Patients with recurrent pericarditis or prior colchicine use before admission were excluded. Patients were categorized as receiving high-dose (≥0.6 mg/day) or low-dose (<0.6 mg/day) colchicine. The primary outcomes were colchicine-related adverse effects and a composite of dose reduction or discontinuation. Secondary outcomes included symptom improvement within 72 hours, recurrent pericarditis, and pericardial tamponade within 12 months. A total of 93 patients were included (53 high-dose and 40 low-dose). Idiopathic pericarditis was the most common etiology in both groups. End-stage kidney disease (57.5% vs. 15%) and dialysis (52.5% vs. 13%) were more common in the low-dose group. High-dose colchicine was associated with more gastrointestinal adverse events (39.6% vs. 12.5%, p=0.004), a higher rate of the composite outcome of dose reduction or discontinuation (41.5% vs. 20%, p=0.043), and more frequent dose reduction alone (30.2% vs. 7.5%, p=0.009), while discontinuation rates were similar. Symptom relief, recurrent pericarditis, and pericardial tamponade were comparable between groups. Initial colchicine doses of less than 0.6 mg daily were associated with improved tolerability in patients with CKD and pericarditis.