Risk of chronic kidney disease in patients with gout and the impact of urate lowering therapy: a population-based cohort study

John Belcher,Sara Muller,Rebecca Whittle,Matthew Roughley,Lorna Clarson,Alyshah Abdul Sultan,Edward Roddy,Christian D. Mallen

doi:10.1186/s13075-018-1746-1

Abstract

BackgroundAn association between gout and renal disease is well-recognised but few studies have examined whether gout is a risk factor for subsequent chronic kidney disease (CKD). Additionally, the impact of urate-lowering therapy (ULT) on development of CKD in gout is unclear. The objective of this study was to quantify the risk of CKD stage ≥ 3 in people with gout and the impact of ULT.MethodsThis was a retrospective cohort study using data from the Clinical Practice Research Datalink (CPRD). Patients with incident gout were identified from general practice medical records between 1998 and 2016 and randomly matched 1:1 to patients without a diagnosis of gout based on age, gender, available follow-up time and practice. Primary outcome was development of CKD stage ≥ 3 based on estimated glomerular filtration rate (eGFR) or recorded diagnosis. Absolute rates (ARs) and adjusted hazard ratios (HRs) were calculated using Cox regression models. Risk of developing CKD was assessed among those prescribed ULT within 1 and 3 years of gout diagnosis.ResultsPatients with incident gout (n = 41,446) were matched to patients without gout. Development of CKD stage ≥ 3 was greater in the exposed group than in the unexposed group (AR 28.6 versus 15.8 per 10,000 person-years). Gout was associated with an increased risk of incident CKD (adjusted HR 1.78 95% CI 1.70 to 1.85). Those exposed to ULT had a greater risk of incident CKD, but following adjustment this was attenuated to non-significance in all analyses (except on 3-year analysis of women (adjusted HR 1.31 95% CI 1.09 to 1.59)).ConclusionsThis study has demonstrated gout to be a risk factor for incident CKD stage ≥ 3. Further research examining the mechanisms by which gout may increase risk of CKD and whether optimal use of ULT can reduce the risk or progression of CKD in gout is suggested.

Highlights

An association between gout and renal disease is well-recognised but few studies have examined whether gout is a risk factor for subsequent chronic kidney disease (CKD)
We identified patients with CKD stage ≥ 3 or more based on a recorded diagnosis of CKD stages 3–5, end-stage renal disease (ESRD) or having evidence of renal replacement therapy (RRT) in their primary or secondary care medical record
Patients with gout had a higher prevalence of diabetes mellitus, hypertension, vascular disease and obesity

Summary

Introduction

An association between gout and renal disease is well-recognised but few studies have examined whether gout is a risk factor for subsequent chronic kidney disease (CKD). The objective of this study was to quantify the risk of CKD stage ≥ 3 in people with gout and the impact of ULT. The rate of progression to renal replacement therapy (RRT) or death over 5 years in patients with CKD stage 3 is 1.3% and 24.3%, respectively, and with stage 4 it is 19.9% and 45.7%, respectively [8]. The association between hyperuricaemia, gout and CKD is thought to be bidirectional, with CKD known to be an independent risk factor for gout [10,11,12,13] and gout potentially predisposing to CKD by a number of mechanisms including hyperuricaemia, chronic inflammation and drug therapy with non-steroidal anti-inflammatory

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