Relationship of Gout, Serum Urate, and CKD Progression

The directionality of the relationship between gout and chronic kidney disease (CKD) is unclear. Gout is a risk factor for CKD development and progression, while CKD is a risk factor for hyperuricemia and gout.

Michael Garshick and others examined the longitudinal relationship between CKD and serum urate (SU) by assessing CKD stage prevalence after the first gout diagnosis in a UK population. They shared the results at the National Kidney Foundation Spring Clinical Meetings.

Data came from the Adults in The Health Improvement Network (THIN) database. Study subjects had their first gout code (index) in 2003-2021, data ≥2 years prior to index, and ≥5 postgout SU values. Researchers grouped subjects into quartiles by mean postindex SU. Using the highest-stage code, the researchers examined CKD prevalence at index and each following year. Patients could move in and out of stages, with increases in CKD stages 3-5 representing overall CKD progression.

There were 18,253 patients who met the study criteria (78% men; 59 ± 15 years old; SU at index: 8.4 ± 1.6 mg/dL; in database: 7.3 ± 4.5 years/11.5 ± 4.8 years before/after index). Despite oral uric acid-lowering therapy use in 93% of patients, mean postindex SU was 7.1 ± 1.3 mg/dL (82% SU >6 mg/dL). The average postgout SU was 5.5, 6.7, 7.5, and 8.7 mg/dL in Q1, Q2, Q3, and Q4, respectively. SU quartiles were similar (including hypertension, hyperlipidemia, and diabetes), except for mean age (Q1 vs Q4: 62 vs 59 years) and index SU (7.4 vs 9.5 mg/dL). The highest prevalence of CKD stages 3-5 was in SU Q4. SU Q4 also had the lowest CKD stages 1-2 prevalence increase, similar CKD stage 3 prevalence increase, and highest CKD stages 4-5 prevalence increase compared with Q1-Q3.

The study results did not demonstrate causality or directionality, but the authors noted that they do support an association between hyperuricemia and CKD progression.

Source: Garshick M, Kumar A, Padnick-Silver L, et al. CKD following gout diagnosis and potential influence of serum urate levels: a UK THIN database study. Abstract presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.