Analysis Identifies Four Risk Factors for Gout in Patients With CKD

There are limited data available on the association between asymptomatic hyperuricemia and the development of gout in patients with stage 3-5 chronic kidney disease (CKD). Researchers at Shamir Medical Center Assaf, Tzrifin, Central, Israel, conducted a retrospective study designed to examine the prevalence of gout among that patient population and determine the risk factors associated with the development of gout.

During a poster session at ASN Kidney Week 2024, Ilia Beberashvili, MD, presented results of the study. The poster was titled Incidence and Risk Factors of Gout in Nondialysis-Dependent Patients With CKD and Asymptomatic Hyperuricemia.

The analysis included data from ambulatory patients with CKD in a clinical database. Eligible patients were nondialysis-dependent and had asymptomatic hyperuricemia and no prior history of gout. Data from 2010 to the present were analyzed. Rome criteria were used to diagnose gout during the follow-up period; the diagnoses were confirmed by the institution’s rheumatology clinic. Risk factors were identified using a Cox proportional hazards model with backward conditional elimination. The independent risk factors included age, use of a diuretic, uric acid level, and creatinine level.

The study cohort included 771 patients with nondialysis-dependent CKD stage 3-5. Average age of the cohort was 72 years and 44% were women. The median follow-up was 47 months. During the follow-up period, 18% of the cohort developed gout.

ROC curve analysis was utilized to determine cutoff points for continuous variables. The four identified risk factors were combined into a scoring system based on multivariate logistic regression coefficients, allowing for the estimation of gout risk.

The hazard ratio for patients with CKD <71 years of age with regular use of diuretics, uric acid levels above 8.3 mg/dL, and creatinine levels below 1.5 mg/dL was 2.25 (95% CI, 1.60-3.16). Following adjustment for multiple variables, including the Charlson Comorbidity Index and body mass index, the association remained significant.

“Gout prevalence is high among CKD patients with asymptomatic hyperuricemia,” the authors said. “Early treatment aimed at lowering blood uric acid levels may be beneficial for high-risk populations. These findings warrant further validation through interventional studies.”

Source: Beberashvili I, Nizri E, Efrati S. Incidence and risk factors of gout in nondialysis-dependent patients with CKD and asymptomatic hyperuricemia. FR-PO1118. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2024; October 25, 2024; San Diego, California.