From the Guidelines
Chronic kidney disease (CKD) has the highest age- and sex-adjusted odds ratio in people with gout. According to the 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout 1, systematic assessment for the presence of associated comorbidities in people with gout is recommended, including renal impairment. This recommendation highlights the importance of screening and managing comorbidities frequently associated with gout. The identification of CKD is crucial as it has therapeutic implications, and patients with gout are approximately 2-3 times more likely to have CKD compared to those without gout.
Some key points to consider:
- The relationship between gout and CKD is bidirectional, with kidney disease reducing uric acid excretion, worsening hyperuricemia and gout, while gout and hyperuricemia can accelerate kidney damage.
- Other significant comorbidities associated with gout include hypertension, diabetes, cardiovascular disease, and metabolic syndrome, but CKD demonstrates the strongest statistical association when adjusting for age and sex.
- Monitoring kidney function in gout patients and considering renal status when selecting appropriate gout treatments is essential, as emphasized in the EULAR recommendations for the management of gout 1.
Key comorbidities to consider in gout patients:
- Obesity
- Renal impairment
- Hypertension
- Ischaemic heart disease
- Heart failure
- Diabetes
- Dyslipidaemia However, CKD stands out as the comorbidity with the highest age- and sex-adjusted odds ratio in people with gout, making it a critical factor to consider in the management of gout patients 1.
From the Research
Comorbid Conditions in Gout
- The comorbid conditions associated with gout include hypertension, chronic kidney disease, coronary artery disease, and hyperlipidemia 2.
- Chronic kidney disease (CKD) is a common comorbidity in patients with gout, with a prevalence of 16.6% in a study of patients with CKD in the Irish health system 3.
- The prevalence of gout increases with worsening kidney function, with 22.8% of patients with stage 4-5 CKD having gout 3.
Age- and Sex-Adjusted Odds Ratio
- A study found that the age- and sex-adjusted odds ratio for gout was highest for chronic kidney disease (stage 3 or worse) compared to other comorbid conditions 3.
- Specifically, the odds ratio for gout in patients with CKD was 1.11 (1.01-1.22) per 5 ml/min/1.73m2 lower eGFR, indicating a significant association between CKD and gout 3.
- Hypertension is also a common comorbidity in patients with gout, but the study did not provide a direct comparison of the age- and sex-adjusted odds ratio for hypertension versus CKD 2, 3.
Comparison of Comorbid Conditions
- While hypertension is a common comorbidity in patients with gout, the available evidence suggests that CKD has a higher age- and sex-adjusted odds ratio for gout 2, 3.
- Coronary artery disease and hyperlipidemia are also comorbidities associated with gout, but the evidence does not provide a direct comparison of their age- and sex-adjusted odds ratios with CKD 2.
- Therefore, based on the available evidence, CKD (stage 3 or worse) appears to have the highest age- and sex-adjusted odds ratio in people with gout 3.