Gout Among Dialysis Patients: Prevalence, Associated Factors, Treatment Patterns, and Outcomes; Population-Based Retrospective Cohort Study

Background: An association between gout and non-dialysis chronic kidney disease has long been recognized, yet limited research exists regarding prevalence, treatment, anemia management, and outcomes in end-stage renal disease (ESRD) patients undergoing dialysis. Methods: Using data from US Renal Data System (USRDS), we conducted a population-based retrospective cohort study in adult patients covered by Medicare and on dialysis in 2017. Multivariate logistic regression models were used to estimate potential factors and odds of gout diagnosis. Anti-gout medications and impact on anemia management were assessed and compared between gout and non-gout dialysis patients using descriptive and regression analyses. Associations for all-cause mortality and cardiovascular-related hospitalizations during 1-year of study follow-up were compared between gout and non-gout patients using multivariate Cox regression models. Results: Of 231,841 ESRD Medicare patients in 2017 undergoing continuous dialysis, 31,300 (13.5%) had 1 or more gout diagnostic code(s). Increased odds of having a gout diagnosis were independently associated with older age, male gender, Asian race, obesity, hypertension, and cardiovascular disease. Gout diagnosis was associated with higher prevalence for anemia as indicated by increased erythropoietin-stimulating-agent (ESA) requirements (OR=1.18 for high vs. low ESA dose, 95% 1.14 to 1.22) and likelihood of blood transfusions (OR=1.34, 95% CI 1.30 to 1.38). During the 1-year study follow-up, mortality among gout vs non-gout patients was higher by 3% (95% CI: 0-6%), and a composite association of mortality and cardiovascular disease hospitalization was higher by 6% (95% CI: 3-9%) after adjusting for comorbid conditions. Conclusions: A gout diagnosis was found in 13.5% of US dialysis-dependent patients and was associated with a higher burden of comorbid cardiovascular conditions as well as an elevated incidence of hospitalization and mortality. These observations improve our current understanding of gout among the dialysis population and highlight the importance of new and better treatments to improve outcomes.