Use of diuretics and risk of incident gout: a population-based case-control study.
OBJECTIVE
Use of diuretics has been associated with an increased risk of gout. Data on different types of diuretics are scarce. We undertook this study to investigate the association between use of loop diuretics, thiazide or thiazide-like diuretics, and potassium-sparing agents and the risk of developing incident gout.


METHODS
We conducted a retrospective population-based case-control analysis using the General Practice Research Database established in the UK. We identified case patients who were diagnosed as having incident gout between 1990 and 2010. One control patient was matched to each case patient for age, sex, general practice, calendar time, and years of active history in the database. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs), and we adjusted for potential confounders.


RESULTS
We identified 91,530 incident cases of gout and the same number of matched controls. Compared to past use of diuretics from each respective drug class, adjusted ORs for current use of loop diuretics, thiazide diuretics, thiazide-like diuretics, and potassium-sparing diuretics were 2.64 (95% CI 2.47-2.83), 1.70 (95% CI 1.62-1.79), 2.30 (95% CI 1.95-2.70), and 1.06 (95% CI 0.91-1.23), respectively. Combined use of loop diuretics and thiazide diuretics was associated with the highest relative risk estimates of gout (adjusted OR 4.65 [95% CI 3.51-6.16]). Current use of calcium channel blockers or losartan slightly attenuated the risk of gout in patients who took diuretics.


CONCLUSIONS
Use of loop diuretics, thiazide diuretics, and thiazide-like diuretics was associated with an increased risk of incident gout, although use of potassium-sparing agents was not.
University of Basel and University Hospital Basel, Basel, Switzerland.
Saskia
S
Bruderer
Michael
M
Bodmer
Susan S
SS
Jick
Christoph R
CR
Meier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D062865:Diuretics, Potassium Sparing / Q000627:therapeutic use*; D005260:Female; D006073:Gout / Q000453:epidemiology*; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D062865:Diuretics, Potassium Sparing; D049993:Sodium Chloride Symporter Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors