THE LINK BETWEEN GOUT AND KIDNEY DISEASE

Gout has historically been referred to as a rheumatologic disease resulting from elevated uric acid levels.1

But over the past 2 decades, this view has evolved…

Increasing evidence indicates that hyperuricemia and gout are associated with renal disease and may be a risk factor for CKD.2-7

CKD Impact on Gout Prevalence

The prevalence of gout dramatically increases with decreasing glomerular function3

Gout prevalence chartGout prevalence chartGout prevalence chart

  • Patients with moderate-to-severe CKD have a 10‑fold increase in gout prevalence3
  • Impaired renal excretion of uric acid is the dominant cause of hyperuricemia in the majority of patients with gout1
  • One-third of patients with >stage 3 CKD have gout3

*Adapted by Krishnan E. Post hoc, cross sectional analysis of National Health and Nutrition Examination Survey (NHANES) data from 2009–2010 of adults >20 years of age.3

Gout Can Impact the Risk of CKD

  • Patients with gout and sUA >7 mg/dL had a 43% higher risk of kidney disease than patients with gout who had lower sUA levels4
    • In these patients, an sUA >7 mg/dL also significantly predicted a higher risk of new onset kidney disease, after controlling for baseline characteristics4

sUA, serum uric acid.

†Study included adult male patients with gout and free of kidney disease identified in the Veterans Administration VISN 16 database and were followed until incidence of kidney disease, death, or last available observation (2002–2011). High sUA was defined as average sUA levels >7 mg/dL (n=1,204); low sUA was defined as ≤7 mg/dL (n=912).4

High sUA Levels May Lead to an Increased Risk of CKD4†

Time to first diagnosis of kidney diseaseTime to first diagnosis of kidney disease Time to first diagnosis of kidney disease

Do declines in sUA levels correlate with improvement/prevention of CKD?

More prospective studies are needed to confirm or deny that a causal link exists between uric acid levels and CKD progression

Prevalence

  1. Terkeltaub R, et al. Arthritis Res Ther. 2006;8(suppl 1):S4.

  2. Sato Y, et al. Nat Rev Nephrol. 2019;15:767-775.

  3. Krishnan E. PLoS One. 2012;7:e50046.

  4. Krishnan E, et al. J Rheumatol. 2013;40:1166-1172.

  5. Oh TR, et al. Scientific Reports. 2019;9:6681.

  6. Singh JA, et al. BMC Nephrology. 2019;20:93.

  7. Stack AG, et al. BMJ Open. 2019;9:e031550.