Session Information
Date: Tuesday, October 23, 2018
Title: Metabolic and Crystal Arthropathies – Basic and Clinical Science Poster II
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Decreased renal excretion of urate is an established risk factor for hyperuricemia, whereas it is less clear if hyperuricemia or gout predict impaired kidney function. Aims were to; 1) Determine if gout predicted ESRD and what the predictors for ESRD were in gout and control subjects separately, 2) describe the underlying kidney diagnoses for ESRD.
Methods:
All patients aged ≥18 with a visit to physician with a gout diagnosis (ICD-10) between 2002 and 2012 in the Western Sweden Health Care Region (WSHCR) were individually matched with 5 general population controls (GP) by age, sex, county and year of gout diagnosis. In all subjects, for the two years preceding the gout diagnosis, visits to physician with the following diagnoses (ICD10) were identified: atrial fibrillation (AF), diabetes (DM), glomerulonephritis (GN), heart failure (HF), hypertension (HT), ischemic heart disease (IHD), and tubulointerstitial nephritis (TIN). Follow-up started Jan 1st 2002 or at the date of first visit with a gout diagnosis thereafter and ended at the first of ESRD diagnosis, death, or end of study (31st of December 2012). ESDR was defined as first kidney transplantation or start of dialysis during follow-up. Multivariable Cox-regression models with ESRD as outcome were used to examine gout as a predictor and individual predictors in the gout and control cohorts separately. In addition descriptive information on underlying kidney disease diagnoses for ESRD are shown.
Results:
We identified 28304 patients with a diagnosis of gout and 135287 GP. In gout patients and GP 0.76% (mean follow-up: 3.92 yrs) and 0.12% (mean follow-up: 4.35 yrs) developed ESRD, respectively. Gout was associated with an increased risk for ESRD (HR 7.2; 95% Confidence Interval (CI) 6.0 to 8.6) compared to GP controls. The HRs for risk factors for ESRD were similar between gout and GP with the exception of male sex and age that decreased the risk in patients with gout (Table 1). Interestingly, when identifying causes to ESDR we found that GN and TIN were significantly more common in gout patients compared to GP controls, 21.6 vs 11.9 % (p=0,005) and 8.4 vs 3.6% (p=0.052) respectively. Diabetic nephropathy was slightly more common in GP controls compared to gout patients, 20.7 vs 18.7% (p=0.59).
Conclusion:
ESRD is much more common in gout patients compared to GP, with a similar pattern of predictors, with the exception of age and sex. Interestingly, TIN was much more frequent in gout patients both overall and as a cause of ESRD, which may reflect presence of urate nephropathy.
|
|
Gout cases, n=28304 |
Gout hazard ratio (SD) |
General population controls, n=135287 |
General population controls, hazard ratio (SD) |
|
Age at inclusion, year, mean (SD) |
68.7(14.9) |
0.98 (0.97-0.99) |
68.1(14.8) |
1.01(0.994-1.02) |
|
Sex, male % |
67.2 |
0.94(0.7-1.27) |
66.5 |
2.72(1.81-4.1) |
|
Atrial fibrillation, % |
16.7 |
0.86(0.56-1.3) |
5.8 |
0.8(0.45-1.4) |
|
Diabetes, % |
16.2 |
2.25(1.67-3.03) |
7.5 |
3.43(2.41-4.89) |
|
Heart failure, % |
13.4 |
2.04 (1.35-3.08) |
2.9 |
2.48(1.45-4.24) |
|
Hypertension, % |
49.2 |
3.68(2.62-5.17) |
25.3 |
3.18(2.26-4.47) |
|
Ischemic heart disease, % |
21.0 |
1.35(0.96-1.89) |
9.5 |
1.59(1.08-2.34) |
|
Non-diabetic glomerular disease, % |
0.7 |
17.34(11.8-25.4) |
0.1 |
47.14(25.4-87.4) |
|
Tubulointerstitial nephritis, % |
0.7 |
6.1(3.56-10.47) |
0.3 |
6.87(2.93-16.14) |
Table 1
Predictors for risk of developing end-stage renal disease, prevalence at baseline and multivariate COX-regression for gout and general population controls, analysis was adjusted for all variables in the table
To cite this abstract in AMA style:
Joelsson M, Jacobsson L, Dehlin M. Predictors of End-Stage Renal Disease (ESRD) in Gout Patients and General Population (GP) Controls – a Role for Interstitial Nephritis, Urate Nephropathy? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/predictors-of-end-stage-renal-disease-esrd-in-gout-patients-and-general-population-gp-controls-a-role-for-interstitial-nephritis-urate-nephropathy/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-end-stage-renal-disease-esrd-in-gout-patients-and-general-population-gp-controls-a-role-for-interstitial-nephritis-urate-nephropathy/