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. 2019 Aug 28;9(8):e031550.
doi: 10.1136/bmjopen-2019-031550.

Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study

Austin G Stack  1 , Michelle Elizabeth Johnson  2 , Betina Blak  3 , Alyssa Klein  4 , Lewis Carpenter  2 , Robert Morlock  5 , Andrew R Maguire  2 , Victoria L Parsons  2
Affiliations

Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study

Austin G Stack et al. BMJ Open. .

Abstract

Objective: Evaluate the association between gout and risk of advanced chronic kidney disease (CKD).

Design: Retrospective matched cohort study.

Setting: UK Clinical Practice Research Datalink.

Participants: The analysis included data for 68 897 patients with gout and 554 964 matched patients without gout. Patients were aged ≥18 years, registered at UK practices, had ≥12 months of clinical data and had data linked with Hospital Episode Statistics. Patients were excluded for history of advanced CKD, juvenile gout, cancer, HIV, tumour lysis syndrome, Lesch-Nyhan syndrome or familial Mediterranean fever.

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 (diagnostic codes in Read system or International Classification of Diseases, Tenth Revision); (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.

Results: Advanced CKD incidence was higher for patients with gout (8.54 per 1000 patient-years; 95% CI 8.26 to 8.83) versus without gout (4.08; 95% CI 4.00 to 4.16). Gout was associated with higher advanced CKD risk in both unadjusted analysis (HR, 2.00; 95% CI 1.92 to 2.07) and after adjustment (HR, 1.29; 95% CI 1.23 to 1.35). Association was strongest for ESKD (HR, 2.13; 95% CI 1.73 to 2.61) and was present for eGFR <10 mL/min/1.73 m² (HR, 1.45; 95% CI 1.30 to 1.61) and serum creatinine doubling (HR, 1.13; 95% CI 1.08 to 1.19) but not CKD-associated death (HR, 1.14; 95% CI 0.99 to 1.31). Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23; 95% CI 1.17 to 1.29) and analysis limited to patients with incident gout (HR, 1.28; 95% CI 1.22 to 1.35).

Conclusions: Gout is associated with elevated risk of CKD progression. Future studies should investigate whether controlling gout is protective and reduces CKD risk.

Keywords: chronic renal failure; dialysis; end-stage renal failure; epidemiology.

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Conflict of interest statement

Competing interests: AGS received funding from AstraZeneca to design the study protocol and provide scientific expertise. VLP, MEJ, LC and ARM were employed by OXON Epidemiology Ltd at the time of the study, which has received funding from AstraZeneca to conduct the study and develop the manuscript. BB, AK and RM were employed by AstraZeneca at the time of the study, which funded the study.

Figures

Figure 1
Figure 1
Study participant flow diagram. CKD, chronic kidney disease; CPRD, Clinical Practice Research Datalink; eGFR, estimated glomerular filtration rate; HES, Hospital Episode Statistics; ONS, Office for National Statistics; ULT, urate-lowering therapy.
Figure 2
Figure 2
Illustration of study population selection and study periods. CPRD, Clinical Practice Research Datalink; HES, Hospital Episode Statistics; ONS, Office for National Statistics.
Figure 3
Figure 3
Cumulative probability of advanced chronic kidney disease among patients with and without gout. CKD, chronic kidney disease.
Figure 4
Figure 4
Adjusted HR for the risk of advanced chronic kidney disease for patients with gout versus without among subgroups with history of comorbidities, which were identified a priori as clinically important patient characteristics.
See this image and copyright information in PMC

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