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The Incidence and Risk Factors of Gout in Non-dialysis Chronic Kidney Disease Patients With Asymptomatic
Ilia Beberashvili1, Hamza Abu Marsa2, Keren Doenyas-Barak1
1Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Israel.
Insights
Gout frequently develops in patients with chronic kidney disease (CKD) and high uric acid. Younger age, higher urate, lower creatinine, and diuretic use are key risk factors for gout onset in these patients.
Area of Science:
- Nephrology
- Rheumatology
- Epidemiology
Background:
- Gout is a common complication in patients with chronic kidney disease (CKD).
- The incidence and specific risk factors for gout in CKD patients with asymptomatic hyperuricemia are not well understood.
- This study addresses the knowledge gap regarding gout development in this specific patient population.
Purpose of the Study:
- To determine the incidence of gout in nondialysis patients with CKD and asymptomatic hyperuricemia.
- To identify specific clinical and laboratory risk factors associated with gout onset in this cohort.
- To inform potential preventive strategies for gout in high-risk CKD patients.
Main Methods:
- A retrospective cohort study was conducted involving 771 ambulatory nondialysis patients with CKD (stages 3-5) and asymptomatic hyperuricemia (serum urate ≥7.0 mg/dL).
- Patients were followed from 2010 to 2023, with incident gout diagnoses confirmed by rheumatology specialists.
- Cox proportional hazards models and receiver operating characteristic curve analyses were used to evaluate predictors, including demographics, comorbidities, medications, and biochemical markers.
Main Results:
- Over a median follow-up of 47 months, 140 patients (18.2%) developed gout, with an incidence rate of 41.9 cases per 1,000 person-years.
- Independent predictors for gout included younger age (HR, 0.97), higher serum urate (HR, 1.29), lower serum creatinine (HR, 0.81), and diuretic use (HR, 1.86).
- A composite weighted index derived from these predictors was significantly associated with increased gout risk (HR, 2.19).
Conclusions:
- Incident gout is a common occurrence in patients with CKD and asymptomatic hyperuricemia.
- Key predictors of gout onset are younger age, elevated serum urate, lower serum creatinine, and the use of diuretics.
- Identifying patients at high risk for gout through these factors can guide preventive treatment decisions.
Rationale & Objective:
Gout frequently complicates chronic kidney disease (CKD), yet the incidence and specific risk factors for gout in patients with CKD and asymptomatic hyperuricemia remain unclear. We aimed to determine gout incidence and risk factors in nondialysis patients with CKD and asymptomatic hyperuricemia.
Study Design:
Retrospective cohort study.
Setting & Participants:
Analysis of 771 ambulatory nondialysis patients with CKD (stages 3-5) with asymptomatic hyperuricemia (serum urate level, ≥7.0 mg/dL), without prior gout, followed from 2010 to 2023 at a single center.
Predictors:
Multiple clinical and laboratory factors were evaluated, including demographics, comorbidities, medications, and biochemical markers.
Outcomes:
Incident gout diagnosis confirmed by rheumatology specialists.
Analytical Approach:
Cox proportional hazards models and receiver operating characteristic curve analyses. A composite weighted index was derived from regression-based predictors.
Results:
Over a median follow-up of 47 months, gout developed in 140 (18.2%) patients (incidence rate, 41.9 cases per 1,000 person-years). Independent predictors of gout included younger age (per year; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.96-0.99), higher serum urate (per 1 mg/dL; HR, 1.29; 95% CI, 1.14-1.46), lower serum creatinine levels (per 1 mg/dL; HR, 0.81; 95% CI, 0.65-0.99), and diuretic use (HR, 1.86; 95% CI, 1.00-3.45). Higher composite weighted index (per 1 unit; HR, 2.19; 95% CI, 1.70-2.83) was associated with increased gout risk.
Limitations:
Single-center, retrospective study design limits generalizability and causal inference.
Conclusions:
Incident gout is common among patients with CKD and asymptomatic hyperuricemia. Younger age, elevated serum urate levels, lower creatinine levels, and diuretic use significantly predict gout onset. Identifying high-risk patients using these predictors could guide preventive therapeutic decisions.
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