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BMC Rheumatol. 2019 Mar 19;3:11. doi: 10.1186/s41927-019-0060-0. eCollection 2019.

Incident gout and chronic Kidney Disease: healthcare utilization and survival.

Author information

1
Kantar Health, Ariel Sharon St 4, 52511 Ramat-Gan, Israel.
2
2AstraZeneca, Medical Evidence and Observational Research Centre, 200 Orchard Ridge Drive, Gaithersburg, MD USA.
3
Clalit Research Institute, Zamenhoff 42, Floor - 1, 6435331 Tel Aviv, Israel.
4
4Kantar Health, Foster City, CA USA.
5
YourCareChoice, Ann Arbor, MI USA.
6
6Evidera, Waltham, MA USA.
7
7Kantar Health, Horsham, PA USA.
8
8Beilinson Hospital, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel.

Abstract

Background:

Uncontrolled gout can cause significant joint and organ damage and has been associated with impairments in quality of life and high economic cost. Gout has also been associated with other comorbid diseases, such as chronic kidney disease. The current study explored if healthcare resource utilization (HRU) and survival differs between patients with incident gout in the presence or absence of chronic kidney disease (CKD).

Methods:

Clalit Health Services (CHS) data were used to conduct a retrospective population-based cohort study of incident gout between 1/1/2006-31/12/2009. Incident cases of gout were identified and stratified by CKD status and by age group (< 55 and 55+ years). CKD status was defined as a pre-existing diagnosis of chronic kidney disease, chronic renal failure, kidney transplantation, or dialysis at index date. Demographic and clinical characteristics, as well as healthcare resource use, were reported.

Results:

A total of 12,940 incident adult gout patients, with (n = 8286) and without (n = 4654) CKD, were followed for 55,206 person-years. Higher rates of HRU were observed for gout patients with CKD than without. Total annual hospital admissions for patients with gout and CKD were at least 3 times higher for adults < 55 (mean = 0.51 vs 0.13) and approximately 1.5 times higher for adults 55+ (mean = 0.46 vs 0.29) without CKD. Healthcare utilization rates from year 1 to year 5 remained similar for gout patients < 55 years irrespective of CKD status, however varied according to healthcare utilization by CKD status for gout patients 55+ years. The 5-year all-cause mortality was higher among those with CKD compared to those without CKD for both age groups (HR< 55 years = 1.65; 95% CI 1.01-2.71; HR55+ years = 1.50; 95% CI 1.37-1.65).

Conclusions:

The current study suggests important differences exist in patient characteristics and outcomes among patients with gout and CKD. Healthcare utilization differed between sub-populations, age and comorbidities, over the study period and the 5-year mortality risk was higher for gout patients with CKD, regardless of age. Future work should explore factors associated with these outcomes and barriers to gout control in order to enhance patient management among this high-risk subgroup.

KEYWORDS:

Chronic kidney disease; Gout; Healthcare utilization; Survival

Conflict of interest statement

This study was approved by the Helsinki Ethics Committee of the CHS (no. 037/2015). The need for consent was waived by the Helsinki Ethics Committee of the CHS (no. 037/2015).Not applicable.DHJ and JC are and NF was an employee of Kantar Health which received fees from AstraZeneca for analysis and reporting. ABK is an employee of AstraZeneca. RM is an employee of Ardea Biosciences, a member of the AstraZeneca Group. DYT was an employee of Evidera. AB was and HG, SMG, BF MLR are employees of the Clalit Research Institute. YM has no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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