Gout Prevalence, Practice Patterns, and Associations with Outcomes in North American Dialysis Patients

Background: Gout occurs frequently in patients with kidney disease and can lead to a significant burden on quality of life. Gout prevalence, and its association with outcomes in hemodialysis (HD) and peritoneal dialysis (PD) populations located in North America, is unknown. Methods: We used data from North America cohorts of 70,297 HD patients (DOPPS, 2012-2020) and 5,117 PD patients (PDOPPS, 2014-2020). We used three definitions of gout for this analysis: (1) having an active prescription for colchicine or febuxostat; (2) having an active prescription for colchicine, febuxostat, or allopurinol, or (3) having an active prescription for colchicine, febuxostat, or allopurinol, or prior diagnosis of gout. Propensity score matching was used to compare outcomes among patients with vs. without gout. Outcomes included erythropoietin resistance index (ERI = ESA dose/(hemoglobin*weight)), all-cause mortality, hospitalization, and patient-reported outcomes (PROs). Results: Gout prevalence was 13% in HD and 21% in PD; it was highest among incident dialysis patients. Description of previous history of gout was rare, and identification of gout defined by colchicine (2-3%) or febuxostat (1%) prescription was less frequent than by allopurinol (9-12%). Both HD and PD patients with gout (vs. no gout) were older, more likely male, with higher BMI, and higher prevalence of cardiovascular comorbidities. About half of patients with a gout history were prescribed urate lowering therapy. After propensity score matching, mean ERI was 3-6% higher for gout vs. non-gout patients, while there was minimal evidence of association with clinical outcomes or PROs. Conclusion: In a large cohort of PD and HD patients in North America, we found that gout occurs frequently and is likely underreported. Gout was not associated with adverse clinical or patient-reported outcomes.