Gout after Living Kidney Donation: Correlations with Demographic Traits and Renal Complications

Abstract

Background: The demographic and clinical correlates of gout after living kidney donation are not well described. Methods: Using a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), we identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies. The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. We also compared the rates of renal diagnoses among donors with and without gout, matched in the ratio 1:3 by age, sex, and race. Results: The study sample of 4,650 donors included 13.1% African Americans. By seven years, African Americans were almost twice as likely to develop gout as Caucasian donors (4.4 vs. 2.4%; adjusted hazard ratio, aHR, 1.8; 95% confidence interval (CI) 1.0-3.2). Post-donation gout risk also increased with older age at donation (aHR per year 1.05) and was higher in men (aHR 2.80). Gout rates were similar in donors and age- and sex-matched general non-donors (rate ratio 0.86; 95% CI 0.66-1.13). Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure (rate ratio 12.5; 95% CI 1.5-107.0), chronic kidney disease (rate ratio 5.0; 95% CI 2.1-11.7), and other disorders of the kidney (rate ratio 2.2; 95% CI 1.2-4.2). Conclusion: Donor subgroups at increased risk of gout include African Americans, older donors, and men. Donors with gout have a higher burden of renal complications after demographic adjustment.

Predonation Prescription Opioid Use: A Novel Risk Factor for Readmission After Living Kidney Donation

“…Presurgical use of opioid analgesics is increasingly recognized as a predictor of postoperative complications and resource utilization in diverse patient populations, including those undergoing general and orthopedic surgery procedures . Pharmacy fill records offer a nonobtrusive measure of medication use in epidemiologic investigations of populations, including living donors and transplant recipients . We recently linked the national transplant registry with fill records from a large pharmacy claims clearinghouse and found that prescription opioid fills in the year before kidney transplantation were associated with increased risk of complications after the transplant procedure .…”

Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

“…A study of 4650 kidney donors from the US including 13.1% African Americans, found that, by 7 years, African Americans were almost twice as likely to develop gout as white donors (4.4% vs 2.4%; adjusted HR, 1.0 1.8 3.2 ). 204 Postdonation gout risk also increased with older age at donation and was nearly 3-times higher in men compared with women. 204 In nondonor populations hyperuricemia is associated with a higher risk of CVD and new-onset CKD.…”

“…204 Postdonation gout risk also increased with older age at donation and was nearly 3-times higher in men compared with women. 204 In nondonor populations hyperuricemia is associated with a higher risk of CVD and new-onset CKD. 203,205 However, the prognostic significance of hyperuricemia in living kidney donors is currently uncertain and warrants additional study.…”

Understanding and Communicating Medical Risks for Living Kidney Donors: A Matter of Perspective

“…A study of 4650 kidney donors from the United States, including 13.1% black donors, found that, by 7 years, black donors were almost twice as likely to develop gout as white donors (4.4% versus 2.4%; aHR, 1.8; 95% CI, 1.0 to 3.2). 49 Postdonation gout risk also increased with older age at donation and was nearly three times higher in men. Compared with matched donors without gout, donors with gout had more frequent diagnoses of renal conditions including ARF, CKD, and other disorders of the kidney.…”