THU0424 SHORT-TERM ADHERENCE OF URATE-LOWERING AGENTS WILL NOT IMPROVE END-STAGE RENAL DISEASE AND MORTALITY

Abstract

Background:Gout is the most common inflammatory arthritis worldwide with a diverse spectrum of clinical manifestations. Many studies indicated that gout is associated with hypertension, metabolic syndrome, chronic kidney disease and ischaemic heart diseases.Objectives:This study investigated the association between the compliance of urate-lowering agents (ULA) compliance and progression end-stage renal disease (ESRD) and all-cause mortality.Methods:We identified 53,917 patients with incident gout from 2002 to 2012. We followed up these patients till 31DEC2015. The primary data source was the National Health Insurance database of Taiwan. Proportion of days covered (PDC) was used to measure medication adherence. Patients with PDC≧80% more than two years defined adherence to ULA. Cox proportional hazards model was used to estimate difference and hazard ratios (HRs) for ESRD and all-cause mortality.Results:A total of 53,917 patients were included (figure 1). Patient with urate-lowering agent PDC≧80% more than 2 years were 2,371. After propensity score matched 1:4 with age, sex and comorbidities, PDC <80% were 9,484 matched cohort (Table 1). The mean follow-up duration is 12.30±2.45 years in PDC≧80% group and 9.52±3.46 years in PDC <80%. During follow-up, ESRD was detected in 1,349 patients (306 with PDC≧80% and 1,043 with PDC <80%) and all-cause mortality was found 3,430 patients (842 with PDC≧80% and 2,588 with PDC <80%). This matching showed no difference in ESRD (HR, 0.91; 95% CI, 0.80-1.03) and all-cause mortality (HR, 0.96; 95% CI, 0.88-1.03) (Table 2).Table 1.Baseline characteristic of adherence and non-adherence of urate-lowering agent among patients with gout in matched and unmatched cohortUnmatched CohortPropensity-score Matched CohortVariablePDC≧80%N=2371^PDC<80%N=51546^PPDC≧80%N=2371^PDC<80%N=9484^PAge (years) (mean ± standard deviation)59.96±13.4451.52±15.61<0.000159.96±13.4460.23±13.410.3755follow-up duration (years) (mean ± standard deviation)12.30±2.459.52±3.46Gender0.30980.2855Male1929(81.36%)42358(82.18%)1929(81.36%)7624(80.39%)Female442(18.64%)9188(17.82%)442(18.64%)1860(19.61%)ComorbiditiesHypertension406(17.12%)3695(7.17%)1.71E-71406(17.12%)1571(16.56%)0.5138Diabetes Mellitus276(11.64%)2367(4.59%)1.78E-54276(11.64%)1080(11.39%)0.7291Ischemic heart disease109(4.60%)988(1.92%)1.58E-19109(4.60%)444(4.68%)0.8617Cerebrovascular disease113(4.77%)891(1.73%)1.05E-26113(4.77%)481(5.07%)0.5416Peripheral arterial disease20(0.84%)170(0.33%)3.67E-0520(0.84%)74(0.78%)0.7561Congestive heart failure81(3.42%)606(1.18%)1.88E-2181(3.42%)286(3.02%)0.3137Anemia182(7.68%)1559(3.02%)5.22E-36182(7.68%)769(8.11%)0.4882CKD266(11.22%)1978(3.84%)2.61E-69266(11.22%)963(10.15%)0.1281Table 2.hazard ratio of ESRD and all-cause mortality in patients with goutOutcomeHazard ratio (95% Confidence interval)ESRDULA adherence level PDC<80%Reference PDC≧80%0.91 (0.80-1.03)All-cause mortalityULA adherence level PDC<80%Reference PDC≧80%0.96 (0.88-1.03)PDC= Proportion of days coveredFigure 1.Flow chart for study designConclusion:Gout patients with/without two years adherence of urate-lowering agents does not have an impact on ESRD and all-cause mortality.