Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study

Abstract

ObjectiveEvaluate the association between gout and risk of advanced chronic kidney disease (CKD).DesignRetrospective matched cohort study.SettingUK Clinical Practice Research Datalink.ParticipantsThe analysis included data for 68 897 patients with gout and 554 964 matched patients without gout. Patients were aged ≥18 years, registered at UK practices, had ≥12 months of clinical data and had data linked with Hospital Episode Statistics. Patients were excluded for history of advanced CKD, juvenile gout, cancer, HIV, tumour lysis syndrome, Lesch-Nyhan syndrome or familial Mediterranean fever.Primary and secondary outcome measuresAdvanced CKD was defined as first occurrence of: (1) dialysis, kidney transplant, diagnosis of end-stage kidney disease (ESKD) or stage 5 CKD (diagnostic codes in Read system or International Classification of Diseases, Tenth Revision); (2) estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m²; (3) doubling of serum creatinine from baseline and (4) death associated with CKD.ResultsAdvanced CKD incidence was higher for patients with gout (8.54 per 1000 patient-years; 95% CI 8.26 to 8.83) versus without gout (4.08; 95% CI 4.00 to 4.16). Gout was associated with higher advanced CKD risk in both unadjusted analysis (HR, 2.00; 95% CI 1.92 to 2.07) and after adjustment (HR, 1.29; 95% CI 1.23 to 1.35). Association was strongest for ESKD (HR, 2.13; 95% CI 1.73 to 2.61) and was present for eGFR <10 mL/min/1.73 m² (HR, 1.45; 95% CI 1.30 to 1.61) and serum creatinine doubling (HR, 1.13; 95% CI 1.08 to 1.19) but not CKD-associated death (HR, 1.14; 95% CI 0.99 to 1.31). Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23; 95% CI 1.17 to 1.29) and analysis limited to patients with incident gout (HR, 1.28; 95% CI 1.22 to 1.35).ConclusionsGout is associated with elevated risk of CKD progression. Future studies should investigate whether controlling gout is protective and reduces CKD risk.

Report of Native Arteriovenous Fistulas on End Stage of Chronic Kidney Disease Patients in Indonesia

“…In addition, the research of Arbol et al and also Baghel et al showed that CKD was most commonly caused by DM glomerulonephritis, but Arbol et al found that the second most common cause was hypertension [9,10]. Stack et al showed that patients with hyperuricemia had a 29% higher risk of suffering from advanced CKD than patients without gout (HR, 1.29, 95% CI 1.23-1.35) [4].…”

“…Some of the most common risk factors for CKD are diabetes mellitus, hypertension, and other causes such as glomerulonephritis, polycystic kidney disease, kidney vascular disorders, chronic urinary tract obstruction, vesicoureteral reflux, and recurrent pyelonephritis [1]. However, at this time many new risk factors have also been investigated, such as elevated uric acid and gout [4].…”

Predictors of Success in Gout Treatment

“…The need to effectively manage gout is increasingly recognized as important because (1) gout is prevalent, and increasingly so, despite the proven effectiveness of urate-lowering therapies (ULT) such as allopurinol 2,3,4 ; (2) the effect on individuals, their families, and society has been significantly underappreciated 5,6 ; and (3) the documented poor adherence to ULT (< 50%) 7 has been moderately resistant to a wide range of interventions 8,9,10,11 . Further, there is increasing concern that poorly controlled gout is a harbinger of premature and serious cardiovascular and/or renal impairments 9,12 .…”

Uric acid level and kidney function: a cross-sectional study of the Korean national health and nutrition examination survey (2016–2017)

“…According to a study examining the association between serum uric acid levels and kidney disease in Korean men, elevated serum uric acid levels were independently associated with an increased likelihood of CKD 16 . In addition, a recent study examining the association between gout and the risk of advanced CKD found that patients with gout had a higher incidence of advanced CKD than those without 17 .…”