Journal Article

Gout is associated with a higher risk of chronic renal disease in older adults: a retrospective cohort study of U.S. Medicare population

Cleveland, John D., Singh, Jasvinder A.

2019

Overview

Background Hyperuricemia and gout have been linked to chronic kidney disease (CKD) . Whether the increased risk of CKD in gout is due to shared risk factors such as hypertension, diabetes or heart disease, or due to gout itself is not known. Studies in older adults, who tend to have a high incidence of CKD, are limited. Our objective was to assess whether gout was associated with incident CKD in older adults. Methods Using the 5% random sample of Medicare claims, we assessed whether gout is associated with higher risk of incident (new) CKD in adults 65 years or older, using multivariable-adjusted Cox regression analyses, adjusting for demographics (age, gender, race), medical comorbidity and common medications. We calculated hazard ratios (HR) and 95% confidence interval (CI). Sensitivity analyses varied comorbidity variable (models 2, 3), or limited CKD to the most specific codes. Results Of the 1,699,613 eligible people, 168,065 developed incident CKD; 150,162 people without gout and 17,903 people with gout. Respective crude incidence rates were 15.6 vs. 78.1 per 1000 person-years. We found that gout was associated with a higher risk of incident CKD in multivariable-adjusted analyses, HR was 3.05 (95% CI, 2.99, 3.10), with minimal attenuation in sensitivity analyses, with HR 2.96 (95% CI, 2.91, 3.01) (model 2, categorical Charlson-Romano) and 2.59 (95% CI, 2.54, 2.63) (model 3, individual Charlson-Romano comorbidities plus hypertension, heart disease, obesity, coronary artery disease). Sensitivity analyses that limited the CKD diagnostic codes to more specific codes, confirmed findings from the main models with respective HRs of 3.10 (95% CI, 3.05, 3.15; Model 1), 3.03 (95% CI, 2.97, 3.08; Model 2) and 2.60 (95% CI, 2.56, 2.65; Model 3). Conclusion Gout was associated with a 3-fold higher risk of CKD, confirmed in multiple sensitivity analyses. Future studies should provide insights into underlying mechanisms that are responsible for an increased CKD risk in gout.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age Factors / Aged / Aged, 80 and over / Cardiovascular disease / Chronic kidney disease / Chronic kidney failure / Cohort analysis / Cohort Studies / Complications and side effects / Coronary artery / Coronary artery disease / Demography / Diabetes mellitus / Elderly / Epidemiology and Health Outcomes / Female / Gout / Gout - diagnosis / Gout - epidemiology / Health aspects / Heart diseases / Humans / Hypertension / Hyperuricemia / Internal Medicine / Kidney diseases / Male / Medicare / Medicare - trends / Medicine / Medicine & Public Health / Nephrology / Older adults / Older people / Population Surveillance - methods / Renal Insufficiency, Chronic - diagnosis / Renal Insufficiency, Chronic - epidemiology / Research Article / Retrospective Studies / Risk / Risk Factors / Sensitivity analysis / Statistics / Studies / United States - epidemiology