WASHINGTON—New-onset gout among kidney transplant recipients increases the risks of transplant complications and return to maintenance hemodialysis (HD), according to results from 2 new studies presented at the American Society of Nephrology’s Kidney Week 2019 meeting.
In one study, Megan Francis-Sedlak, PhD, and colleagues from Horizon Therapeutics in Lake Forest, Illinois, identified 6085 kidney transplant recipients within the Humana Research Claims Database, including 909 who experience gout before transplant and 595 who experienced gout (a mean 1.8 years) afterward. Gout patients tended to be older, male (68%-69%), and white (56%-58%).
Patients with gout had a significant 28% higher risk for transplant-related complications than those without gout: 40.4% vs 35.3%, respectively, after matching for age, sex, and race. Recipients with new-onset gout after transplantation drove the higher rates of complications: 50.9% for post-transplant gout vs 33.4% for pre-transplant gout vs 34.6% for no gout.
In addition, patients with post-transplant gout had twice the risk of experiencing complications than patients without gout. In particular, those with post-transplant gout were more likely to experience graft failure: 16.2% vs 10.9% for vs 11.6% for post-transplant, pre-transplant, and no gout, respectively. Although a smaller proportion of patients with pre- than post-transplant gout had complications, complications developed more quickly in those with pre-transplant gout: mean 245 vs 510 days.
“An increased focus on awareness and screening of renal transplant patients for gout is warranted,” according to Dr Francis-Sedlak and colleagues.
In the other second study, which included 21,553 patients in the US Renal Data System who received a primary kidney transplant during 2008 to 2016, new-onset gout developed in 7%, 19% died, and 11% returned to HD 6 or more months after transplant.
Patients with post-transplant gout had a significant 38% higher risk of returning to HD than those without gout, Justin W. Li, BA, of Trinity Partners in Waltham, Massachusetts, and colleagues reported. The risk of returning to HD among patients with post-transplant gout increased by 49%, 30%, 29%, 49%, and 53% at years 1 through 5 after transplant, respectively.
The findings suggest new-onset gout may be a predictor of longer-term renal dysfunction in kidney transplant recipients, Li’s team stated. “Further research is needed to understand the interactions between hyperuricemia, gout, renal dysfunction, and return to dialysis across both short and long-time horizons post-KT [kidney transplantation].”
Hyperuricemia in kidney transplant recipients is known to be associated with use of the calcineurin inhibitor immunosuppressants, cyclosporine A, and tacrolimus, the investigators noted.
The studies were funded by Horizon Therapeutics.
Francis-Sedlak M, LaMoreaux B, Holt RJ. Renal transplant complications in patients with and without gout. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10 in Washington DC. Abstract FR-PO1170.
Li JW, Miyasato G, Wang Z, et al. Assessing the relationship between gout and return to hemodialysis among renal transplant patients. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5-10 in Washington DC. Abstract FR-PO1171.