Subscribe
VBCR - April 2013, Volume 2, No 2 - Practice Management, Gout

By analyzing information from the National Health and Nu­trition Examination Survey (NHANES) from 1988-1994 and 2007-2010, researchers have uncovered a 30% rate of gout prevalence among Americans with severe chronic kidney disease (CKD). They also found significantly higher rates of gout among individuals with lower average estimated glomerular filtration rates (eGFRs) or higher levels of albuminuria, even after adjusting for uric acid levels (Juraschek SP, et al. Semin Arthritis Rheum. 2013 Jan 8 [Epub ahead of print]).

“Health practitioners treating patients with CKD who have new-onset joint pain or swelling should be vigilant for undiagnosed gout,” noted Allan C. Gelber, MD, PhD, Associate Professor of Medicine at the Johns Hopkins Bloomberg School of Public Health, Baltimore, and his coauthors in their write-up of the study. “Moreover, practitioners treating patients with gout should be wary of CKD as an underlying factor contributing to both hyperuricemia and gout risk, because many urate-lowering medications require renal dosing or have associated nephrotoxicity.”

Dr Gelber and his colleagues looked at the signals produced by levels of albuminuria, serum uric acid, hyperuricemia, and eGFR among 15,132 adults in the 1988-1994 NHANES and 10,814 adults in the 2007-2010 NHANES.

The overall prevalence of gout among Americans was 2.7% in the 1988-1994 time frame and 3.7% during 2007-2010. In both periods, there was an inverse relationship between the proportion of patients with a reduced eGFR and gout or hyperuricemia, and a direct relationship between increased albuminuria and gout or hyperuricemia. The mean eGFR for patients with gout was 76 mL/min/1.73 m2 to 82 mL/min/1.73 m2, whereas for people without gout it was 97 mL/min/1.73 m2 to 102 mL/min/1.73 m2.

Similarly, in both NHANES timeframes, approximately 1% to 2% of people with eGFRs of ≥90 mL/min/1.73 m2 had gout compared with 30% among those with eGFRs of <30 mL/min/1.73 m2. The team observed a similar pattern for albuminuria, even after adjusting for factors such as age, sex, race/ethnicity, hypertension, body mass index, and diabetes.

“One of the more impressive aspects of our findings is the dose-response relationship. Incremental changes in eGFR, albuminuria, and CKD are associated with a higher prevalence of gout. And these findings were not merely relegated to persons with severe CKD,” Stephen Juraschek, an MD/PhD student in epidemiology at Johns Hopkins University, said. “Furthermore, we found that the relationship persisted even after accounting for multiple risk factors associated with both CKD and gout, including uric acid levels.”

Related Items
Increased Risk for Erectile Dysfunction Among Men with Gout
Sophie Granger
VBCR - August 2017, Vol 6, No 3 published on August 23, 2017 in Gout
Lesinurad Added to Allopurinol Improves Outcomes in Patients with Gout
Anne Rowe
VBCR - June 2017, Vol 6, No 2 published on June 29, 2017 in Gout
Allopurinol May Reduce Risk for Cardiovascular Events in Patients with Gout and Diabetes
Rebecca Bailey
VBCR - June 2017, Vol 6, No 2 published on June 29, 2017 in Gout
Patients with Gout and Poorly Controlled Comorbid Osteoarthritis Can Benefit from Earlier Treatment
Leslie Wyatt
VBCR - April 2017, Vol 6, No 1 published on May 3, 2017 in Gout
Patient Tip: 5 Tips for Easing or Preventing Gout Attacks
VBCR - December 2016, Vol 5, No 6 published on January 5, 2017 in Gout
EULAR Updates Its Gout Guidelines with New Treatment Recommendations
Alice Goodman
VBCR - August 2016, Vol 5, No 4 published on August 25, 2016 in Gout
Better Disease Control Needed in Patients with Gout
E. K. Charles
VBCR - April 2016, Vol 5, No 2 published on April 29, 2016 in Gout
Better Understanding of Patients with Gout Needed
Alice Goodman
VBCR - February 2016, Vol 5, No 1 published on March 15, 2016 in Gout
New Gout Classification Criteria Released
Rosemary Frei, MSc
VBCR - December 2015, Volume 4, No 6 published on December 15, 2015 in Gout
Insurance Company, MD
Kyle C. Harner, MD
VBCR - August 2015, Volume 4, No 4 published on August 26, 2015 in Practice Management
Last modified: May 21, 2015
  • Rheumatology Practice Management
  • Lynx CME
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology