Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study.
OBJECTIVE: Evaluate the association between gout and risk of advanced chronic kidney disease (CKD).
DESIGN: Retrospective matched cohort study.
SETTING: UK Clinical Practice Research Datalink.
PARTICIPANTS: The analysis included data for 68 897 patients with gout and 554 964 matched patients without gout. Patients were aged >/=18 years, registered at UK practices, had >/=12 months of clinical data and had data linked with Hospital Episode Statistics. Patients were excluded for history of advanced CKD, juvenile gout, cancer, HIV, tumour lysis syndrome, Lesch-Nyhan syndrome or familial Mediterranean fever.
PRIMARY AND SECONDARY OUTCOME MEASURES: Advanced CKD was defined as first occurrence of: (1) dialysis, kidney transplant, diagnosis of end-stage kidney disease (ESKD) or stage 5 CKD (diagnostic codes in Read system or International Classification of Diseases, Tenth Revision); (2) estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m(2); (3) doubling of serum creatinine from baseline and (4) death associated with CKD.
RESULTS: Advanced CKD incidence was higher for patients with gout (8.54 per 1000 patient-years; 95% CI 8.26 to 8.83) versus without gout (4.08; 95% CI 4.00 to 4.16). Gout was associated with higher advanced CKD risk in both unadjusted analysis (HR, 2.00; 95% CI 1.92 to 2.07) and after adjustment (HR, 1.29; 95% CI 1.23 to 1.35). Association was strongest for ESKD (HR, 2.13; 95% CI 1.73 to 2.61) and was present for eGFR <10 mL/min/1.73 m(2) (HR, 1.45; 95% CI 1.30 to 1.61) and serum creatinine doubling (HR, 1.13; 95% CI 1.08 to 1.19) but not CKD-associated death (HR, 1.14; 95% CI 0.99 to 1.31). Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23; 95% CI 1.17 to 1.29) and analysis limited to patients with incident gout (HR, 1.28; 95% CI 1.22 to 1.35).
CONCLUSIONS: Gout is associated with elevated risk of CKD progression. Future studies should investigate whether controlling gout is protective and reduces CKD risk.
|投稿者||Stack, Austin G; Johnson, Michelle Elizabeth; Blak, Betina; Klein, Alyssa; Carpenter, Lewis; Morlock, Robert; Maguire, Andrew R; Parsons, Victoria L|
|組織名||Graduate Entry Medical School & Health Research Institute, University of;Limerick, Limerick, Ireland email@example.com.;OXON Epidemiology, London, UK.;AstraZeneca, Luton, UK.;AstraZeneca, Gaithersburg, Maryland, USA.;YourCareChoice, Ann Arbor, Michigan, USA.|