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Abstract: PO0792

Risk Factors and Outcomes of Gout in Dialysis Patients: A Cohort Study of the United States Renal Data System (USRDS)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bleyer, Anthony J., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • Zhang, Yi, Medical Technology and Patterns Institute, Bethesda, Maryland, United States
  • Kshirsagar, Onkar S., Medical Technology and Patterns Institute, Bethesda, Maryland, United States
  • Marder, Brad, Horizon Therapeutics plc, Deerfield, Illinois, United States
  • LaMoreaux, Brian, Horizon Therapeutics plc, Deerfield, Illinois, United States
Background

Limited research exists regarding gout among dialysis-dependent end-stage renal disease patients. This study aimed to evaluate the epidemiology, risk factors, and outcomes of dialysis patients with gout.

Methods

Using 2017 USRDS data, this study identified dialysis patients ≥18 years of age with Medicare as the primary payer. Baseline characteristics and comorbid conditions for dialysis-dependent patients with gout were assessed at dialysis initiation as well as 3-months preceding their gout diagnosis and compared with non-gout dialysis patients. All-cause hospitalization and mortality risk were also estimated and compared between gout and non-gout patients.

Results

Of 275,651 dialysis patients in 2017, 41,312 (15%) had ≥1 gout claims following initiation of chronic outpatient dialysis. More than 1/3 of gout diagnoses were made by internal and family medicine physicians. Compared to non-gout patients, gout patients were more likely to be older (mean 64.5 vs 56.8 y), male (62% vs 54%), of Asian race (6.2% vs 3.7%), and obese (31.4 vs 30.2 kg/m2). Gout patients were also found to be more likely to undergo hemodialysis via central venous catheter (15% vs 13%). Gout patients had a higher comorbidity prevalence of diabetes (67% vs 62%), hypertension (93% vs 74%), and cardiovascular conditions (heart failure [49% vs. 30%], ischemic heart disease [49% vs 30%], peripheral vascular disease [32% vs 22%], stroke [12% vs 8%], acute myocardial infarction [7% vs 3%] and angina [4% vs 2%]). Adjusted regression analysis showed that older age (OR=4.23 for ≥65 vs <65 y, 95% CI 4.03-4.43), previous transplant (OR=2.37, 95% CI 2.24-2.50), and comorbid hypertension (OR=2.71, 95% CI 2.59-2.83) are the 3 most significant factors associated with gout diagnosis. In multivariate analysis, risk of hospitalization and mortality was higher by 11% (95% CI 8-13%) and 9% (95% CI 5-12%), respectively in the year after diagnosis.

Conclusion

The prevalence of gout was 15% in the US Medicare dialysis-dependent population. Gout patients had a higher comorbidity burden especially for cardiovascular conditions and higher risk of hospitalization and mortality. Future studies are needed to elucidate whether improved recognition and management of gout may reduce the risk for worse cardiovascular outcomes.

Funding

  • Commercial Support – Horizon Therapeutics