Nearly 25% of patients with chronic kidney disease meet gout criteria
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Key takeaways:
- Patients with uncontrolled gout had additional burdens including elevated rates of hypertension.
- Only 64% of patients meeting criteria for gout had a formal diagnosis.
Approximately 23% of patients with chronic kidney disease meet the criteria for gout, of whom 13% have uncontrolled gout and 36% have no formal gout diagnosis, according to data published in Gout, Urate, and Crystal Deposition Disease.
The study additionally found that patients with chronic kidney disease and gout demonstrate significantly more cardiovascular comorbidities and bone diseases.
“Better recognition and improved management of patients with the coincidence of gout and chronic kidney disease is essential to improve patient outcomes,” Richard J. Johnson, MD, of the University of Colorado Anschutz Medical Campus, and study co-author, told Healio. “Data have shown that approximately one-in-four people with moderate-to-advanced CKD have gout, but gout is often not recognized as an important part of managing patient outcomes.”
To analyze the prevalence and impact of gout on CKD, Johnson and colleagues conducted a retrospective chart review study of 746 U.S. patients (mean age, 56.2 years) with CKD between stages three and five. Deidentified patient records were submitted by nephrologists on a panel representative of U.S. health care providers, with each submitting four to eight records. The researchers examined the prevalence of gout and its potential health impacts, assessing between-group differences using two-tailed unpaired t-tests and two-tailed chi-square tests.
Presence of gout was defined as records indicating gout as a comorbidity, use of urate-lowering therapy or clinical evidence, such as tophi or flares. Uncontrolled gout was defined as serum greater than 6 mg/dL at the most recent visit, and at least one of the following: visible tophi, more than two flares in the prior year or more than one swollen or tender joint.
Overall, 23% of the patients with CKD met criteria for gout, with prevalence highest among those in stage 3b or stage four, according to the researchers. Among the 173 patients with gout, 13% had uncontrolled gout.
“Despite many databases demonstrating the high prevalence rate of gout among patients with underlying CKD, nephrologists often find these data surprising,” study co-author Brad A. Marder, MD, medical director at Amgen, which funded the study, told Healio. “Many times, when the data is presented, the reaction is that this is not representative of what occurs in a practice.”
However, this study of “practicing nephrologists’ own medical records” revealed “that gout is extremely common in patients with CKD stage 3 or worse,” he said.
In addition, just 64% of those who met study criteria for gout had gout listed as a comorbidity in their records. According to Johnson, that finding — coupled with another result suggesting that one-third of patients with a gout diagnosis were not on urate-lowering therapy — represented “a clear call to action for clinicians.”
“Despite similar demographics and renal function, patients with gout had higher comorbidity and more bone/joint-related issues,” he said. “This suggests an opportunity to better manage CKD patient outcomes through better gout diagnosis and management.”
Compared with patients who did not have gout, those with gout had significantly higher prevalence of ischemic heart disease (23% vs. 13%, P = .004), CKD-mineral bone disorder (40% vs. 26%, P < .001) and chronic back pain (13% vs. 6%, P = .008). Compared with patients with controlled gout, those with uncontrolled gout demonstrated elevated rates of hypertension (43% vs. 26%), as well as higher use of febuxostat (43% vs. 14%, P < .001) and colchicine (26% vs. 7%, P = .005).
According to Marder, the associations of gout with CKD-mineral bone disorder and back pain were “interesting” and warrant further study. He added that following this study, a prospective trial “will be important to determine how a nephrologist’s more diligent identification and management of gout might benefit their complex patients’ health and quality of life.”
“These data show a fuller picture of how gout may negatively impact the health of patients with advanced CKD, including cardiovascular and bone health,” Johnson said. “Additionally, this study indicates that gout as a disease could be better managed. Our data suggest that improved management of gout in CKD patients could represent an important opportunity to improve overall patient health and wellbeing, particularly with respect to bone and joint health.”
Perspective
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Daniel J. Wallace, MD, FACP, MACR
In a large, retrospective study of patients with chronic kidney disease conducted by Columbia University, the prevalence of gout was highest in patients with stage 3b and 4 disease. Interestingly, many of the patients were not listed or labelled as having gout even though it was present.
The gout group demonstrated more hypertension, joint issues, chronic pain, febuxostat use, colchicine use and cardiovascular complications vs. those with chronic kidney disease without gout. This important survey emphasizes the utility of separating out those with hyperuricemia/gout and more aggressively addressing their comorbidity issues from a standpoint of proactive engagement.
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