Background Traditionally, diabetes mellitus (DM) and hypertension have been considered the most important risk factors for CKD. Since gout frequently coexists with diabetes mellitus (DM) and hypertension, it is often overlooked as a genuine risk factor for chronic kidney disease (CKD) and subsequent end-stage renal disease (ESRD).
Objectives To determine whether gout is an independent risk factor for ESRD by analyzing the data obtained for a representative cohort of the general population in Taiwan.
Methods The primary database used was the Taiwan National Health Insurance Research Dataset. Subjects older than 20 years without ESRD, coronary heart disease, or stroke were included in the study. The case definition of gout in the present study was gout diagnosis and medical treatment for gout. An ESRD case was defined by the presence of chronic renal failure necessitating long-term renal replacement therapy. Multivariate Cox proportional hazards models were used to evaluate the risk of ESRD among gout patients.
Results The analysis included data of 656,108 patients who were followed up for a mean of 8.0 years. Among them, 19,963 (3.0%) patients had gout. There were 2,377 (gout, n=276; non-gout, n=2,101) had ESRD, and 861 (gout, n=77, 27.9%; non-gout, n=521, 24.8%) died due to ESRD. The incidence of ESRD was 1.73 and 0.41 cases per 1000 patient-years in the gout and non-gout groups. As shown in Table 1, gout was associated with a hazard ratio (HR) of 1.57 for ESRD (95% confidence interval [CI], 1.38–1.79; p<0.001), after adjustment for age, sex, and history of diabetes mellitus and/or hypertension. We also explored the association between gout and ESRD in 3 age groups (20–44 years, 45–59 years, and ≥60 years). Risk for ESRD in gout patients was higher among older subjects. For those aged 20 to 44 years, gout was not independently associated with ESRD, after adjustment for age, sex, DM and/or hypertension. However, gout was associated with HRs of 1.41 and 1.58 for ESRD in patients aged 45–59 years and ≥60 years (Table 2). In patients with ESRD, the adjusted HR for death in patients with gout was 0.95 (0.74–1.23, p=0.71), which was similar to the HR obtained in patients without gout.
Conclusions Gout is a risk factor for developing ESRD, independent of DM and hypertension.
Disclosure of Interest None Declared