Gout Increases Risk of Advanced Chronic Kidney Disease

Chronic kidney disease (CKD) is a major public health epidemic, with at least 1 in 10 individuals having some degree of kidney impairment, contributing substantially to adverse clinical and economic outcomes.

Gout is the most common inflammatory arthritis, which causes severe pain and suffering due to a build-up of uric acid in joints. It affects almost 2.5 % of the adult population and causes significant pain and disability due to its effects on joints, tendons and bone.

A team of scientists working with the University of Limerick (Limerick, Ireland) analyzed the risk of advanced chronic kidney disease (CKD) in 68,897 gout patients followed for an average of 3.7 years and compared them to 554,964 patients without gout. The primary and secondary outcome measures: Advanced CKD was defined as first occurrence of: (1) dialysis, kidney transplant, diagnosis of end-stage kidney disease (ESKD) or stage 5 CKD; (2) estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m²; (3) doubling of serum creatinine from baseline and (4) death associated with CKD.

The team reported that advanced CKD incidence was higher for patients with gout (8.54 per 1000 patient-years) versus without gout (4.08). Gout was associated with higher advanced CKD risk in both unadjusted analysis (Hazard ratio [HR], 2.00) and after adjustment (HR, 1.29). Association was strongest for ESKD (HR, 2.13) and was present for eGFR <10 mL/min/1.73 m² (HR, 1.45) and serum creatinine doubling (HR, 1.13), but not CKD-associated death (HR, 1.14) Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23) and analysis limited to patients with incident gout (HR, 1.28).

Austin G. Stack, MBBCh, MD, MSc, FASN, FRCPI, a Professor of Medicine and the lead author of the study, said, “We discovered that patients who suffered from gout had a 29% higher risk of advanced CKD compared to those without gout. Indeed when we analyzed each of the components of advanced kidney disease, we found that in general gout patients were at higher risk of deterioration in kidney function compared to those without. Astonishingly, when we looked at the risk of kidney failure and those who needed dialysis or a kidney transplant, we found that gouts patients had more than a 200% higher risk of kidney failure than those without gout.” The study was published on August 28, 2019, in the journal BMJ Open.

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University of Limerick