Prevalence and correlates of gout in a large cohort of patients with chronic kidney disease: the German Chronic Kidney Disease (GCKD) study.
BACKGROUND
Reduced kidney function is a risk factor for hyperuricaemia and gout, but limited information on the burden of gout is available from studies of patients with chronic kidney disease (CKD). We therefore examined the prevalence and correlates of gout in the large prospective observational German Chronic Kidney Disease (GCKD) study.


METHODS
Data from 5085 CKD patients aged 18-74 years with an estimated glomerular filtration rate (eGFR) of 30-<60 mL/min/1.73 m(2) or eGFR ≥60 and overt proteinuria at recruitment and non-missing values for self-reported gout, medications and urate measurements from a central laboratory were evaluated.


RESULTS
The overall prevalence of gout was 24.3%, and increased from 16.0% in those with eGFR ≥60 mL/min/1.73 m(2) to 35.6% in those with eGFR <30. Of those with self-reported gout, 30.7% of individuals were not currently taking any gout medication and among gout patients on urate lowering therapy, 47.2% still showed hyperuricaemia. Factors associated with gout were serum urate, lower eGFR, advanced age, male sex, higher body mass index and waist-to-hip ratio, higher triglyceride and C-reactive protein (CRP) concentrations, alcohol intake and diuretics use. While lower eGFR categories showed significant associations with gout in multivariable-adjusted models (prevalence ratio 1.46 for eGFR <30 compared with eGFR ≥60, 95% confidence interval 1.21-1.77), associations between gout and higher urinary albumin-to-creatinine ratio in this CKD population were not significant.


CONCLUSIONS
Self-reported gout is common among patients with CKD and lower GFR is strongly associated with gout. Pharmacological management of gout in patients with CKD is suboptimal. Prospective follow-up will show whether gout and hyperuricaemia increase the risk of CKD progression and cardiovascular events in the GCKD study.
Renal Division, Medical Center-University of Freiburg, Freiburg, Germany.
Jiaojiao
J
Jing
Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
Jan T
JT
Kielstein
Renal Division, Medical Center-University of Freiburg, Freiburg, Germany.
Ulla T
UT
Schultheiss
Department of Medicine, Ludwig-Maximilians-University Hospital, Munich, Germany.
Thomas
T
Sitter
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Stephanie I
SI
Titze
Division of Nephrology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany.
Elke S
ES
Schaeffner
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Mara
M
McAdams-DeMarco
Division of Genetic Epidemiology, Innsbruck Medical University, Innsbruck, Austria.
Florian
F
Kronenberg
Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany.
Kai-Uwe
KU
Eckardt
Renal Division, Medical Center-University of Freiburg, Freiburg, Germany.
Anna
A
Köttgen
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006073:Gout / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D049629:Waist-Hip Ratio; D055815:Young Adult
GCKD study; chronic kidney disease; correlates; estimated glomerular filtration rate; gout epidemiology; observational study