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

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.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1746-1) contains supplementary material, which is available to authorized users.

Heart disease and the risk of allopurinol-associated severe cutaneous adverse reactions: a general population–based cohort study

“…Our findings are applicable to patients with gout, in whom there is a high prevalence of comorbid heart disease [30][31][32][33] and chronic kidney disease. [34][35][36] In light of the US Food and Drug Administration's warning 2 regarding potential cardiovascular adverse effects related to febuxostat, 37 allopurinol use among patients receiving treatment for gout who also have chronic kidney disease and heart disease may be set to increase. These findings may also have implications for clinical trials of allopurinol among at-risk populations.…”

Acute Kidney Injury During Fasting in Ramadhan in a Patient With Ephrolithiasis – A Case Report

“…One systematic review and meta-analysis involving 190,000 patients revealed that there was a significant positive association between hyperuricaemia and new onset of CKD (OR 2.35) (Ling Li, 2014). Another population-based retrospective cohort study in the UK demonstrated that gout was associated with an increased incidence of CKD especially those who were exposed to urate lowering agent (Matthew Roughley, 2018). They also have higher prevalence of diabetes mellitus, hypertension, and vascular disease which also highly correlated with CKD, and received more NSAIDs than patient without gout (Matthew Roughley, 2018).…”

“…Another population-based retrospective cohort study in the UK demonstrated that gout was associated with an increased incidence of CKD especially those who were exposed to urate lowering agent (Matthew Roughley, 2018). They also have higher prevalence of diabetes mellitus, hypertension, and vascular disease which also highly correlated with CKD, and received more NSAIDs than patient without gout (Matthew Roughley, 2018). Hence, patient with gout like our patient should be suspected to have CKD, and they should be advised to be cautious on taking NSAIDs during Ramadan fasting to avoid acute deterioration of kidney function.…”

Establishment of A Clinical Diagnostic Model for Gouty Arthritis Based on Serum Biochemical Profile: A Prospective Study

“…Studies have shown that chronically high levels of uric acid in the blood could significantly increase the risk of kidney disease [31], and 5.6% of 13338 participants(mean serum uric acid = 5.9 ± 1.5 mg/dL) had incident kidney disease defined by GFR decrease of more than 30% over 8.5 years [32]. Another population-based cohort study showed that patients with CGA who were treated with urate-lowering therapy (ULT) had a greater risk of incident chronic kidney disease (CKD) [33]. Therefore, BUN and creatinine could be regarded as IRFs for the progression of GA, and the significant rising of BUN and creatinine indicates that the course of GA has entered the CGA stage.…”