Gout is associated with an increased risk of advanced chronic kidney disease (CKD), according investigators.
A large retrospective cohort study of data from patients in the UK health system found that patients with gout, compared with those who did not have the condition, had a significant 29% increased risk advanced CKD and 210% increased risk of end-stage renal disease (ESRD), after adjusting for potential confounding variables, investigators led by Austin G. Stack, MD, of the Graduate Entry Medical School & Health Research Institute, University of Limerick, Limerick, Ireland, reported in BMJ Open.
In addition, the presence of gout, compared with its absence, was significantly associated with a 45% increased risk of an estimated glomerular filtration rate (eGFR) below 10 mL/min/1.73 m2 and 13% increased risk of a doubling of serum creatinine in adjusted analyses.
The relationship between gout and advanced CKD was not explained by the prevailing burden of medical conditions, use of nonsteroidal anti-inflammatory drugs, lifestyle factors, or differences in socioeconomic factors measured at baseline, the investigators pointed out.
“The overall findings add to the accumulating body of evidence that gout is an independent risk factor for kidney disease progression, although further work is needed to establish whether adequate control of gout can reduce the risk of CKD progression,” Dr Stack and his colleagues concluded.
Dr Stack’s team analyzed data on 68,897 patients with gout and 554,964 matched patients without gout identified from primary care practices and captured in the UK Clinical Practice Research Datalink. The investigators identified patients with gout based on a clinical record of the condition or a prescription for urate-lowering therapy. They defined advanced CKD as a composite outcome of the first occurrence of ESRD (initiation of long-term dialysis, receipt of a kidney transplant, diagnosis of ESRD, or stage 5 CKD), an eGFR below 10 mL/min/1.73 m2, a doubling of serum creatinine from baseline, and death associated with CKD. After a median follow-up of 3.7 years, 3452 new cases of CKD developed during 404,035 patient-years in the gout cohort and 10,187 cases developed during 2,498,498 patient-years in the cohort without gout.
Stack AG, Johnson ME, Blak B, et al. Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study [published online August 28, 2019]. BMJ Open. doi:10.1136/bmjopen-2019-031550