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Association of urate-lowering drugs with the risk of future urolithiasis in patients with gout: A population-based
Sheng-Wen Wu1, Chin-Yin Liu2, Chih-Jung Yeh3
1Division of Nephrology, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Insights
Urate-lowering therapy (ULT) does not increase the risk of kidney stones in gout patients. Further research is needed, but high fluid intake is recommended for those on uricosuric agents.
Area of Science:
- Nephrology
- Rheumatology
- Pharmacology
Background:
- Gout patients face a higher risk of urolithiasis (kidney stones).
- Urate-lowering therapy (ULT) is crucial for managing gout progression.
- Limited data exists on the urolithiasis risk associated with ULT use.
Purpose of the Study:
- To investigate the association between ULT and the risk of future urolithiasis in gout patients.
- To analyze the impact of xanthine oxidase inhibitors (XOIs) and uricosuric agents on urolithiasis risk.
Main Methods:
- A nested case-control study utilizing the Taiwan National Health Insurance Research Database (2000-2012).
- Included 2307 gout patients who developed urolithiasis (cases) and 2307 matched controls without urolithiasis.
- Analyzed the association between ULT (XOIs or uricosuric agents) and subsequent urolithiasis.
Main Results:
- No significant association was found between the use of XOIs or uricosuric agents and the risk of future urolithiasis.
- Cumulative prescription data for XOIs and uricosuric agents showed no difference in urolithiasis risk.
- The study included a large cohort with a mean age of 56.3 years, predominantly male (83.2%).
Conclusions:
- Neither XOIs nor uricosuric agents appear to increase the risk of urolithiasis in patients with gout.
- Continued high fluid intake and monitoring for urolithiasis are advised, especially for uricosuric agent users.
- Further clinical evidence is needed to solidify these findings.
Background:
Patients with gout have an increased risk of urolithiasis and usually need urate-lowering therapy (ULT) for the prevention of disease progression. However, there is a paucity of clinical data regarding the risk of future urolithiasis in ULT users.
Methods:
This nested case-control study was performed using the Taiwan National Health Insurance Research Database. The aim of this study was to examine whether ULT (xanthine oxidase inhibitors [XOIs] or uricosuric agents) is associated with risk of future urolithiasis in patients with gout. Data were collected from January 2000 to December 2012.
Results:
This study included 2307 case patients and 2307 matched controls. Case patients had gout that developed into urolithiasis, and control patients had gout but were not diagnosed with urolithiasis during the study period. Patients had a mean age of 56.3 years at diagnosis of gout, and 83.2% were male patients. No association was detected between use of XOIs or uricosuric agents and risk of future urolithiasis. Furthermore, there was no significant difference in the risk of future urolithiasis in patients exposed to various cumulative days of XOI or uricosuric prescriptions.
Conclusion:
The present study provides evidence that neither XOIs nor uricosuric agents are associated with risk of future urolithiasis in patients with gout. Before the availability of more clinical evidence, ensuring high fluid intake and prospective monitoring of urolithiasis development are still important for uricosuric agent users.
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