Background/Purpose:

Appropriate dose of urate-lowering therapy (ULT) is needed for gout patients to dissolve existing urate crystals to prevent acute gout attacks and reduce the risk of urate nephropathy and urolithiasis. This study aimed to investigate the associations between ULT use in different doses and the risk of urolithiasis in incident gout patients.

Methods:

We conducted a nested case-control study in a cohort of incident gout using the UK-based Clinical Practice Research Data-link (CPRD). Overall, 63,095 people with incident gout 1990–2010 were identified. Among them incidence cases of uroithiasis were identified and they were 1:4 age-, sex- and diagnosis year-matched to patients without urolithiasis Conditional logistic regression was used to estimate the association between cumulative defined daily dose (cDDD) and risk of urolithiasis.

Results:

We identified 700 gout patients with incident urolithiasis occurring after the initial diagnosis of gout aged 20-89 matched to 2,800 controls with incident gout but no urolithiasis. After adjusting for body mass index, smoking, alcohol consumption, pertinent drugs and comorbidities, the odds ratio (OR) of urolithiasis associated with use of ULT among gout patients were 1.41 (95% confidence interval [CI], 1.09–1.81) for those with 1–180 cDDD, 0.90 (95% CI, 0.59–1.37) for 180-365 cDDD and 1.01 (95% CI, 0.77–1.31) for > 365 cDDD, compared with those never used. The relative risk for uroithiasis was 0.89 (0.52 to 1.50) for current ULT use (within 30 days), 1.64* (1.12 to 2.41) for recent ULT use (30-180 days) and 1.09 (0.88 to 1.34) for remote ULT use (>180 days) compared with ULT non-users.

Conclusion:

Short-term and low dose ULT use was associated with an increased risk for urolithiasis while adequate ULT dose results in a neutral effect on urolithiasis risk.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-urate-lowering-treatment-on-the-risk-of-urolithiasis-in-people-with-gout/