Association of Gout With Transplant Wait-Listing Among Patients Receiving Hemodialysis

Researchers sought insight into the association between gout, a common condition among patients with chronic kidney disease, and the chances of being added to the kidney transplant wait list among patients receiving hemodialysis. They will present their findings at the National Kidney Foundation Spring Clinical Meetings 2025.

The retrospective cohort study used data from the United States Renal Data System and included 150,176 adults aged 18 to 80 years who began hemodialysis between 2016 and 2019. Medicare was the primary payer for all participants, and gout status was identified via Medicare claim codes.

The first diagnosis after cohort entry was considered a time-varying exposure. The researchers followed up participants from day 91 of end-stage renal disease until transplant wait-listing, death, or December 31, 2021. Death was considered a competing risk when calculating the cumulative incidence of wait-listing. A Fine and Gray proportional subdistribution hazard model was used to conduct multivariate competing risk analysis, adjusted for demographics and comorbidities.

During a median follow-up of 2.3 years (interquartile range, 1.1-3.5), 15,689 patients (10.4%) were wait-listed and 75,257 (50.1%) died. During this period, 26,882 patients (18%) developed gout; these individuals were more likely to be older, male, Asian, obese, and institutionalized and to have cardiovascular comorbidities.

Gout among patients receiving hemodialysis was associated with a lower likelihood of being wait-listed for a kidney transplant. Three years after starting dialysis, the unadjusted cumulative incidence of wait-listing was 5% for patients with gout and 11% for patients without gout. The adjusted subdistribution hazard ratio for wait-listing among participants with gout compared with those without gout was 0.94 (95% CI, 0.88-0.98), representing a 6% lower likelihood of being wait-listed for a kidney transplant. 

Source: Parajuli S, Zhang Y, Marder B. Association of gout with access to kidney transplant waitlisting among hemodialysis patients. Abstract # G-574. Presented at the National Kidney Foundation Spring Clinical Meetings 2025; April 10-13, 2025; Boston, MA. doi:10.1053/j.ajkd.2025.02.575