Background/Purpose: Although gout has been shown to be associated with poor renal outcomes among chronic kidney disease populations, this relationship is not well understood among renal transplant recipients. This analysis compared rates of return to maintenance hemodialysis, a negative transplant outcome, across three primary renal transplant patient cohorts based on gout status: non-gout, pre-existing gout, and new-onset gout following transplantation.

Methods: This retrospective study of the United States Renal Data System examined Medicare beneficiaries who received a primary renal transplant between 2008-2013. Patients’ Medicare claims data were used to identify pre-existing gout in the 2 years prior to transplant and new-onset gout in the 3 years post-transplant. To mitigate the effect of complications associated with acute allograft rejection/ failure, recipients who died, returned to dialysis, or received re-transplantation within 3 years after primary renal transplantation were excluded. Patients’ return to hemodialysis was observed in the period between 3-5 years post-transplantation. The association between gout status (non-gout, pre-existing, and new-onset) and 5-year return to dialysis was evaluated via chi-squared tests.

Results: 39,780 patients received a primary renal transplant between 2008-2013 with Medicare as their primary payer after exclusions. Of these patients, 33,105 (83.2%) were non-gout, 4,747 (11.9%) had pre-existing gout, and 1,928 (4.8%) developed new onset gout post-transplant. 2,211 (5.6%) primary renal transplant recipients returned to hemodialysis between 3 and 5 years post-transplantation. The rate of return to hemodialysis 3 to 5 years after transplantation for non-gout, pre-existing gout, and new onset gout was 5.6, 4.6, and 7.5%, respectively (all pairwise comparisons yielded p< 0.05).

Conclusion: Compared to non-gout and pre-existing gout patients who received a primary renal transplant, patients who developed new-onset gout after transplantation were more likely to require maintenance hemodialysis, a negative renal transplant outcome. Further investigation is needed to determine if the presence and timing of gout relative to renal transplantation is an independent predictor for return to dialysis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-the-relationship-between-gout-and-return-to-hemodialysis-among-u-s-renal-transplant-patients/