Gout Is Associated with Worse Wait-List Outcomes in Patients on Dialysis Awaiting Kidney Transplant

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Background: Gout is common in end-stage kidney disease (ESKD) and may impact health outcomes for patients on the waitlist for a deceased donor kidney transplant (DDKT). We examined the association of gout with the likelihood of receiving a DDKT and waitlist mortality (WM) from the national cohort. Methods: We used the USRDS database to identify 34,528 Medicare insured first-time waitlisted adults between 2016–2019. Each contributed monthly records through December 2021. We used discrete-time (pooled-logistic) models for WM and DDKT, applying generalized estimating equations to account for within-patient correlation. Inverse-probability weighting (IPW) was used to adjust for time-varying confounders (hospitalizations, cardiovascular comorbidities) and censoring due to competing events. From these models, we derived adjusted hazard ratios and cumulative incidence at 1, 3, and 5 years. Results: Over a median 2.7 y, 4,786 (13.9%) patients had ≥1 gout diagnosis post-listing. Patients with gout were older (34.2% vs 20.6% ≥ 65 y), more often male (73.9% vs 62.2%), and had higher prevalence of hypertension (35.4% vs 29.7%) and coronary artery disease (32.8% vs 26.8%). During the observation period, 8,120 had WM, and 11,246 DDKT events occurred. In IPW-weighted analyses, post-listing gout was linked to a 23% higher hazard of waitlist mortality (HR 1.23; 95% CI, 1.14–1.32) and an 11% lower likelihood of DDKT (OR 0.89; 95% CI, 0.81–0.98). Adjusted cumulative incidence estimates at 1, 3, and 5 years are shown in Figure 1. Conclusion: Post-listing gout was associated with higher waitlist mortality and lower likelihood of DDKT, independent of measured confounding and competing risks. These findings highlight the need for clinician awareness and targeted gout prevention to improve survival and transplant access. Funding: Commercial Support - Amgen, Inc.

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