Findings from separate studies presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings zero in on the prevalence, clinical features, risk factors, and outcomes of gout in patients with advanced kidney disease (CKD), including those receiving dialysis.
In a study of 231,841 Medicare patients on dialysis identified using the US Renal Data System database, Anthony J. Bleyer, MD, of Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues found a 13.5% prevalence of gout. In adjusted analyses, patients with gout had a significant 6% increased risk for a composite of death and hospitalization due to cardiovascular causes compared with non-gout patients, Dr Bleyer’s team reported in a poster presentation.
In addition, patients with vs without gout also had significant 34% and 18% increased odds of blood transfusion and higher erythropoiesis-stimulating agent (ESA) dose, respectively, after adjusting for patient demographics, dialysis characteristics, and comorbid condition, the investigators reported. The patients with gout also had higher ferritin levels and lower transferrin saturation compared with non-gout patients.
“This study shows that dialysis patients who have had a diagnosis of gout are at increased of death and anemia,” Dr Bleyer said in an interview. “In my opinion, this likely relates to chronic inflammation and its long term effects. I think more studies need to me done in this area, as gout occurs so commonly in the setting of chronic kidney disease.”
The other study revealed an overall gout prevalence of 23.2% in a cohort of 746 patients with advanced CKD seen by 111 nephrologists. The cohort included 61 solid organ transplant recipients (55 with a renal transplant) and 83 with end-stage kidney disease.
Gout prevalence varied by CKD stage. It was 17.3%, 27.5%, 27.8%, 20.5%, and 10.0% among patients with CKD stage 3a, stage 3b, stage 4, stage 5 (on dialysis), and stage 5 (not on dialysis), respectively, Leonard Stern, MD, of the Columbia University Irving Medical Center in New York, New York, and colleagues reported in a poster presentation.
Gout was associated with increased use of health care resources and greater cardiovascular and bone/joint comorbidity. Compared with patients who did not have gout, those with gout had a significantly higher rate of acute medical care in the year prior to study data collection (29.6% vs 7.1%). At presentation to a nephrologist, significantly higher proportions of patients with vs without gout reported shortness of breath (21.4% vs 13.8%), urination changes (15.0% vs 7.0%), and joint involvement (15.6% vs 6.6%).
Significantly higher proportions of patients with vs without gout had CKD-mineral bone disorder (40% vs 26%), ischemic heart disease (23% vs 13%), congestive heart failure (21% vs 14%), and degenerative joint disease (17% vs 9%), according to the investigators.
Further, among patients with gout, more than one-third were not receiving any urate-lowering therapy, “representing an important opportunity to avoid the long-term sequelae of uncontrolled gout,” the authors wrote.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original references for a full list of authors’ disclosures.
Bleyer AJ, Zhang Y, Kshirsagar O, Marder B, LaMoreaux B. Risk factors and outcomes of gout in dialysis patients from the United States Renal Data System (USRDS). Presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings in Boston, Massachusetts. Poster 206.
Stern L, Johnson RJ, Shakouri P, et al. Clinical features of gout in advanced chronic kidney disease. Presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings in Boston, Massachusetts, April 6-10, 2022. Poster 205.