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Gout linked to nearly 80% increased mortality risk due to renal disease
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Patients with gout have an increased risk for death from certain noncardiovascular conditions, particularly renal disease and diseases of the digestive system, according to data published in Arthritis & Rheumatology.
“Historically, the burden of comorbidities in gout has translated into higher mortality rates,” Ana Beatriz Vargas-Santos, MD, PhD, of the State University of Rio de Janeiro, and colleagues wrote. “This excess mortality among gout patients has been previously attributed mainly to CV causes. ... This burden of excess mortality may reasonably be expected to decrease in the 21th century in line with decreasing rates of overall mortality, including deaths attributable to CV diseases, over the past decade in the general population, and decreasing premature mortality related to rheumatoid arthritis.”
“However, the premature mortality gap in gout seems to have remained stable over the last 16 years,” they added. “Whether this finding of a stable premature mortality gap remains true for the 21st century, and what comorbidities may be contributing to the excess burden of mortality beyond CV diseases in persons with gout requires clarification.”
To analyze cause-specific mortality risks other than cardiovascular disease among patients with gout, compared with those in the general population, Vargas-Santos and colleagues studied data from several population and health registers in Sweden. First, they used the Swedish Population Register to identify all adult residents of the nation’s Skåne region, which included approximately 1 million inhabitants, and then they examined the Skåne Healthcare Register to collect information regarding diagnosed diseases. According to the researchers, the Skåne Healthcare Register includes data on health care visits for all residents of the region between 1998 and 2014.
Vargas-Santos and colleagues identified 19,497 patients with a new diagnosis of gout between Jan. 1, 2003, and Dec. 31, 2013, and matched each, based on age and sex, with up to 10 comparators without gout from a group of 194,947 from the general population. In addition, the researchers used data from the Causes of Death Register to identify underlying mortality causes for all deceased individuals from 2003 until Dec. 31, 2014. The researchers estimated hazard ratios for cause-specific mortality in a multistate Cox model, adjusting for potential confounders.
According to the researchers, patients with gout demonstrated a higher prevalence of chronic kidney disease, as well as metabolic and cardiovascular comorbidities. In addition, gout was associated with a 17% increased risk for allcause mortality overall (HR = 1.17; 95% CI, 1.14-1.21). Regarding causespecific mortality in gout, the most significant risks for death were due to renal disease (HR = 1.78; 95% CI, 1.342.35), diseases of digestive system (HR = 1.56; 95% CI, 1.341.83), cardiovascular conditions (HR = 1.27; 95% CI, 1.221.33) and infections (HR = 1.2; 95% CI, 1.061.35).
The risk for death related to dementia was lower among patients with gout compared with the general population (HR = 0.83; 95% CI, 0.720.97).
“The novel finding of ~80% increased hazard of renal-related mortality among gout patients highlights the need for improved understanding and management of both gout and renal disease,” Vargas-Santos and colleagues wrote. “The finding of 17% lower dementia-related mortality calls for the need to better clarify the relation between hyperuricemia and dementia, while the ~50% higher mortality from diseases of the digestive system and the 20% higher mortality from infections may be at least partly explained by the frequent use of NSAIDs and steroids — drugs that become less necessary with appropriate treatment of hyperuricemia in gout.”
“Finally, our findings suggest important comorbidities beyond CV that may lead to premature mortality in persons with gout,” they added,” highlighting the need for better management of comorbidities.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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