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Background: There is a strong association between gout and kidney disease due to the kidney’s key role in uric acid excretion. 1-4 Several studies have also demonstrated that serum uric acid is an independent risk factor for decline in renal function 1,2 . There are little national data available regarding the clinical burden of kidney disease in gout patients in the US.
Objectives: To estimate the percentage of US hospitalizations with a concomitant diagnosis of gout and either acute or chronic kidney disease compared with percentage of hospitalizations with kidney disease in the general population.
Methods: The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Detailed information including clinical and nonclinical data elements on each hospital stay including International Classification of Diseases (ICD) 10 diagnosis, age, gender, length of stay, payer, charges, and comorbidities etc. is available.
We examined all hospitalizations with acute renal failure (ICD10 codes N170-179), chronic kidney disease stages 3-5 (ICD10 codes N183-185), N19 (unspecified kidney failure), and end-stage renal disease (ICD10 code N186) in persons with gout (ICD 10 codes M10.* and M1A.*) and compared these with hospitalizations with kidney disease in the general US population.
Results: In 2019, there were 35.4 million all-cause hospitalizations in the US. Of these, 7.9 million had a diagnosis of serious kidney disease (22.3%). There were 915,070 hospitalizations with primary or secondary diagnosis of gout in the US (mean age 70.8 years, 68.4% men and 31.6% women). Of these 533,365 hospitalizations (mean age 72.6 years, 65.9% men) also had a concomitant diagnosis of serious kidney disease (58.3%, p<0.0001 compared to general population).
Concomitant diagnosis of serious kidney disease increased with age, reaching 38.3% of all hospitalizations in 65 years and older in the general population compared to 62.5% in persons with gout (p<0.001).
Kidney disease-related hospitalization in the US general and gout populations.
| GENERAL US HOSPITALIZATIONS | US HOSPITALIZATIONS WITH COMORBID GOUT | |||
|---|---|---|---|---|
| Patient Age | Overall Hospitalizations N | Hospitalizations with Serious Kidney Disease n (%) | Overall Hospitalizations N | Hospitalizations with Serious Kidney Disease n (%) |
| 18-44 years | 8,356,284 | 622,170 (7.4%) | 32,445 | 13,480 (41.5%) |
| 45-64 years | 8,440,831 | 2,160,220 (25.6%) | 232,695 | 116,490 (50.1%) |
| ≥65 years | 13,421,154 | 5,257,220 (39.2%) | 649,865 | 414,620 (83.8%) |
| Total in 2019 | 35,419,023 | 7,907,730 (22.3% ) | 915,070 | 533,365 (58.3% ) |
Note: Total numbers include patients 0-17 years old.
Conclusion: Acute and chronic kidney disease are highly prevalent comorbid conditions in overall US hospitalizations. Among patients admitted with a diagnosis of gout, the proportion of kidney dysfunction is significantly higher affecting 58% of these hospitalizations. The high prevalence of kidney dysfunction in hospitalized gout patients in the US may represent an impactful component to the duration, complexity, and costs of hospital care.
REFERENCES:
[1]Jung SW, et al. Am J Physiol Renal Physiol 2020;318:F1327-40.
[2]Obermayr RP, et al. J Am Soc Nephrol 2008;19:2407-13.
[3]Roughley MJ, et al. Arthritis Res Ther 2015;17:90.
[4]Juraschek SP, et al. Semin Arthritis Rheum 2013;42:551-61.
Disclosure of Interests: Gurkirpal Singh Grant/research support from: Horizon Therapeutics (unrestricted research grant), Maanek Sehgal: None declared, Brad Marder Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Alka Mithal: None declared