North America: Gout in Dialysis Patients

A new study found that gout occurs frequently and is often underreported in patients undergoing hemo and peritoneal dialysis. The study results were published in the journal Kidney360.

An increased frequency of gout in renal disease patients causes a significant burden on quality of life. There is huge uncertainty regarding the prevalence of gout, and its association with outcomes in hemodialysis (HD) and peritoneal dialysis (PD) populations in North America. Hence researchers conducted a study to understand the same.

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The study was carried out using data from North American cohorts of 70,297 HD patients (DOPPS, 2012-2020) and 5,117 PD patients (PDOPPS, 2014-2020). Participants were considered to have gout if they had an active prescription for colchicine or febuxostat; or an active prescription for colchicine, febuxostat, or allopurinol; or had an active prescription for colchicine, febuxostat, or allopurinol, or prior diagnosis of gout. A comparison of outcomes among patients with or without gout was done using propensity score matching. Outcomes included:

• Erythropoietin resistance index (ERI=erythropoiesis stimulating agent dose per week/(hemoglobin×weight))
• All-cause mortality
• Hospitalization
• Patient-reported outcomes (PROs)

Results:

• There was a 13% prevalence of gout in HD and 21% in PD, which was highest among incident dialysis patients.
• Description of the previous history of gout was rare, and identification of gout defined by colchicine (2%-3%) or febuxostat (1%) prescription was less frequent than by allopurinol (9%-12%).
• Both HD and PD patients with gout (versus no gout) were mostly old males with higher body mass index and a higher prevalence of cardiovascular comorbidities.
• Urate-lowering therapy was prescribed to nearly half of the patients with a gout history.
• After propensity score matching, mean ERI was 3%-6% higher for gout versus non-gout patients while there was minimal evidence of association with clinical outcomes or PROs.

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Thus, gout was a frequent presentation in PD and HD patients without any adverse clinical outcomes in North America but was frequently underreported.

Further reading: Guedes M, Zhao J, LaMoreaux B, et al. Gout Prevalence, Practice Patterns, and Associations with Outcomes in North American Dialysis Patients. Kidney360. 2023;4(1):54-62. doi: 10.34067/KID.0005392022