Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study
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....
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/8/e031550.full |
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| _version_ | 1850268558393606144 |
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| author | Austin G Stack Michelle Elizabeth Johnson Betina Blak Alyssa Klein Lewis Carpenter Robert Morlock Andrew R Maguire Victoria L Parsons |
| author_facet | Austin G Stack Michelle Elizabeth Johnson Betina Blak Alyssa Klein Lewis Carpenter Robert Morlock Andrew R Maguire Victoria L Parsons |
| author_sort | Austin G Stack |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-24b71ce3d28e435a9d6219e3fcee849b |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-24b71ce3d28e435a9d6219e3fcee849b2025-08-20T01:53:26ZengBMJ Publishing GroupBMJ Open2044-60552019-08-019810.1136/bmjopen-2019-031550Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort studyAustin G Stack0Michelle Elizabeth Johnson1Betina Blak2Alyssa Klein3Lewis Carpenter4Robert Morlock5Andrew R Maguire6Victoria L Parsons7Division of Nephrology, University Hospital Limerick, Limerick, IrelandOXON Epidemiology, London, UKAstraZeneca, Luton, UKAstraZeneca, Gaithersburg, Maryland, USAKing’s College London, London, United KingdomYourCareChoice, Ann Arbor, Michigan, USAOXON Epidemiology, London, UKOXON Epidemiology, London, UKObjective 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.https://bmjopen.bmj.com/content/9/8/e031550.full |
| spellingShingle | Austin G Stack Michelle Elizabeth Johnson Betina Blak Alyssa Klein Lewis Carpenter Robert Morlock Andrew R Maguire Victoria L Parsons Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study BMJ Open |
| title | Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study |
| title_full | Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study |
| title_fullStr | Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study |
| title_full_unstemmed | Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study |
| title_short | Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study |
| title_sort | gout and the risk of advanced chronic kidney disease in the uk health system a national cohort study |
| url | https://bmjopen.bmj.com/content/9/8/e031550.full |
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