Risk of New-Onset CKD, Kidney Failure, and Mortality in Patients with Uncontrolled Gout vs. Controlled Gout

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Background: Gout may worsen kidney health through urate deposition and chronic inflammation. The additional effects of uncontrolled gout (UCG) on kidney relative to controlled gout (CG) are unknown. Methods: This retrospective cohort study used Optum Clinformatics® DataMart® (2016-2024). CG was defined by no flares, no visible tophi during the baseline yr and normal serum urate (SU) levels (pre-index SU<6 mg/dL for 3 mo). Patients (pts) with any stage CKD at baseline were excluded. UCG included pts with flares, tophi or gout-related emergency department visits or hospitalizations with pre-index SU≥6 mg/dL for 3 mo. Outcomes, analyzed separately, included incident renal failure (first occurrence of stage 5 CKD, dialysis, kidney transplant or ESRD), incident CKD (eGFR<60ml/min), and all-cause mortality. We estimated inverse-probability of treatment weights (IPTW) for each cohort using propensity scores. Cox proportional hazard models were used to generate hazard ratios (HRs). Results: 13,736 pts had UCG in the CKD/renal failure outcome cohorts, and 21,292 in the mortality outcome cohort. UCG cohorts were younger (54% vs 68% aged 65+) but had more males (77% vs 61%) and comorbidities, e.g., obesity (24% vs 10%), hypertension (63% vs 39%) than CG cohort. The 3 outcome-specific cohorts shared similar baseline features. After IPTW weighting, UCG compared to CG was associated with a higher risk of new onset of renal failure (HR 3.5; 95%CI 3.2-3.7; incidence rate: 77 vs 27 events per 1000 person-years), CKD eGFR<60ml/min (HR 2.1; 95%CI 2.0-2.2; 101 vs 58 events per 1000 person-years; Fig. 1) and a higher mortality (HR 1.5; 95%CI 1.4-1.6; 60 vs 42 events per 1000 person years). Conclusion: Pts with UCG had higher rates of renal failure, new CKD, and increased mortality vs CG. These data highlight the need for clinician awareness and further research to clarify how better control of gout may improve health outcomes. Funding: Commercial Support - Amgen, Inc.Figure 1. Kaplan-Meier Survival Curves for the CKD and Renal Failure Outcomes in the Uncontrolled and Controlled Gout Groups.

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