Gout after Living Kidney Donation: Correlations with Demographic Traits & Renal

[Clark]

http://www.karger.com/Article/Abstract/381291

American Journal of Nephrology
Vol. 41, No. 3, 2015
Am J Nephrol 2015;41:231-240
(DOI:10.1159/000381291)
Gout after Living Kidney Donation: Correlations with Demographic Traits and Renal Complications
Lam N.N.a · Garg A.X.a · Segev D.L.b · Schnitzler M.A.c, d · Xiao H.c · Axelrod D.e · Brennan D.C.f · Kasiske B.L.g · Tuttle-Newhall J.E.d · Lentine K.L.c, d

Abstract
Background: The demographic and clinical correlates of gout after living kidney donation are not well described. Methods: Using a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), we identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies. The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. We also compared the rates of renal diagnoses among donors with and without gout, matched in the ratio 1:3 by age, sex, and race. Results: The study sample of 4,650 donors included 13.1% African Americans. By seven years, African Americans were almost twice as likely to develop gout as Caucasian donors (4.4 vs. 2.4%; adjusted hazard ratio, aHR, 1.8; 95% confidence interval (CI) 1.0-3.2). Post-donation gout risk also increased with older age at donation (aHR per year 1.05) and was higher in men (aHR 2.80). Gout rates were similar in donors and age- and sex-matched general non-donors (rate ratio 0.86; 95% CI 0.66-1.13). Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure (rate ratio 12.5; 95% CI 1.5-107.0), chronic kidney disease (rate ratio 5.0; 95% CI 2.1-11.7), and other disorders of the kidney (rate ratio 2.2; 95% CI 1.2-4.2). Conclusion: Donor subgroups at increased risk of gout include African Americans, older donors, and men. Donors with gout have a higher burden of renal complications after demographic adjustment.