Gout is associated with a higher risk of chronic renal disease in older adults: a retrospective cohort study of U.S. Medicare population

Jasvinder A Singh,John D Cleveland

doi:10.1186/s12882-019-1274-5

Abstract

BackgroundHyperuricemia and gout have been linked to chronic kidney disease (CKD). Whether the increased risk of CKD in gout is due to shared risk factors such as hypertension, diabetes or heart disease, or due to gout itself is not known. Studies in older adults, who tend to have a high incidence of CKD, are limited. Our objective was to assess whether gout was associated with incident CKD in older adults.MethodsUsing the 5% random sample of Medicare claims, we assessed whether gout is associated with higher risk of incident (new) CKD in adults 65 years or older, using multivariable-adjusted Cox regression analyses, adjusting for demographics (age, gender, race), medical comorbidity and common medications. We calculated hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses varied comorbidity variable (models 2, 3), or limited CKD to the most specific codes.ResultsOf the 1,699,613 eligible people, 168,065 developed incident CKD; 150,162 people without gout and 17,903 people with gout. Respective crude incidence rates were 15.6 vs. 78.1 per 1000 person-years. We found that gout was associated with a higher risk of incident CKD in multivariable-adjusted analyses, HR was 3.05 (95% CI, 2.99, 3.10), with minimal attenuation in sensitivity analyses, with HR 2.96 (95% CI, 2.91, 3.01) (model 2, categorical Charlson-Romano) and 2.59 (95% CI, 2.54, 2.63) (model 3, individual Charlson-Romano comorbidities plus hypertension, heart disease, obesity, coronary artery disease). Sensitivity analyses that limited the CKD diagnostic codes to more specific codes, confirmed findings from the main models with respective HRs of 3.10 (95% CI, 3.05, 3.15; Model 1), 3.03 (95% CI, 2.97, 3.08; Model 2) and 2.60 (95% CI, 2.56, 2.65; Model 3).ConclusionGout was associated with a 3-fold higher risk of CKD, confirmed in multiple sensitivity analyses. Future studies should provide insights into underlying mechanisms that are responsible for an increased CKD risk in gout.

Highlights

One in seven Americans adults, or roughly 30 million people, have chronic kidney disease (CKD) [1]
Gout was associated with a higher hazard of incident CKD in multivariable-adjusted analyses, hazard ratios (HR) was 3.05, with minimal attenuation in sensitivity analyses, with HR 2.96 and 2.59
We found that gout was associated with 3-fold higher hazard of CKD, independent of other risk factors including demographics, medical comorbidity including diabetes, hypertension and cardiovascular disease and the use of medications for cardiovascular disease and gout

Summary

Introduction

One in seven Americans adults, or roughly 30 million people, have chronic kidney disease (CKD) [1]. The prevalence of CKD is even higher in the adults 65–74 years, at one in five men, and one in four women [1]. CKD ranked 18th in the world in 2010 as the cause of death in the global burden of disease study [2]. Systematic reviews and meta-analyses of observational studies linked hyperuricemia. Hyperuricemia and gout have been linked to chronic kidney disease (CKD). Studies in older adults, who tend to have a high incidence of CKD, are limited. Our objective was to assess whether gout was associated with incident CKD in older adults

Objectives

Methods

Results

Discussion

Conclusion