Background/Purpose: It is speculated that gout is a risk factor for kidney disease progression. The aim of this study was to evaluate the association of gout with progression to advanced chronic kidney disease (CKD) in a national study.

Methods: This cohort study used primary care data from the UK Clinical Practice Research Datalink linked to national data on hospitalisation and mortality. From 1/01/2000 to 31/03/2013, each adult case of gout (≥18 years), based on clinical diagnosis or treatment with a urate lowering agent, was matched with up to 10 controls without gout on age, sex, and registered clinical practice. The median follow-up was 3.68 years (interquartile range 1.65-7.04 years). The incidence of advanced CKD (a composite outcome defined as progression to dialysis, kidney transplant, diagnosis of CKD stage 5 or eGFR < 10ml/min, death with CKD, or doubling of the serum creatinine) was estimated and relative risk of advanced CKD was compared in 68,897 gout patients and 554,964 matched controls. Multivariable Cox regression using marginal structural models and propensity-matching methods estimated hazard ratios (HRs) and 95% confidence intervals (CI) for the rate of advanced CKD. Analyses were adjusted for baseline demographic characteristics, 12 individual medical conditions including mild-moderate kidney disease, Charlston comorbidity index, lifestyle factors (drug use and alcohol use), socioeconomic status  (Townsend score) and medication use (defined as treatment with NSAID, oral corticosteroid, angiotensin receptor blocker, angiotensin converting enzyme inhibitor, thiazide diuretic, other diuretic, statin,  or aspirin).

Results: Accounting for baseline differences, patients with gout experienced significantly higher risk of advanced CKD (HR 1.29, 95 % CI (1.23-1.35) compared with those without gout (HR, 1.00 referent group). The findings were similar in the propensity-matched analysis (HR 1.23, 95% CI 1.17-1.29).  

*P < 0.001 for all

Conclusion: Gout is associated with an elevated risk of progression to advanced CKD. Future studies should investigate whether control of gout is protective and reduces future CKD risk.