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Published on: April 13, 2021
Gout after living kidney donation: correlations with demographic traits and renal complications
Ngan N Lam1, Amit X Garg, Dorry L Segev
1Division of Nephrology, Western University, London, Ont., Canada.
Insights
Living kidney donors who are African American, older, or male have a higher risk of developing gout. Gout in donors is associated with increased kidney problems post-donation.
Area of Science:
- Nephrology
- Rheumatology
- Transplant Surgery
Background:
- The risk factors for gout in living kidney donors are not well understood.
- Understanding these factors is crucial for donor health and long-term outcomes.
Purpose of the Study:
- To identify demographic and clinical factors associated with gout development after living kidney donation.
- To assess the renal health outcomes of living kidney donors with gout compared to those without.
Main Methods:
- Utilized a unique database linking U.S. living kidney donor registry data with private health insurance claims.
- Identified post-donation gout using diagnosis codes or medication fills.
- Employed Cox regression for risk analysis and matched comparisons for renal diagnoses.
Main Results:
- African American donors had nearly double the risk of gout compared to Caucasian donors.
- Gout risk increased with older age at donation and was significantly higher in men.
- Donors with gout exhibited higher rates of renal diagnoses, including acute kidney failure and chronic kidney disease.
Conclusions:
- Specific donor subgroups, including African Americans, older individuals, and men, face an elevated risk of post-donation gout.
- Living kidney donors diagnosed with gout experience a greater burden of kidney-related complications.
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.
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