Endocrinol Metab.  2024 Oct;39(5):748-757. 10.3803/EnM.2024.2020.

Impact of Chronic Kidney Disease and Gout on End-Stage Renal Disease in Type 2 Diabetes: Population-Based Cohort Study

• Jung I
• Lee DY
• Chung SM
• Park SY
• Yu JH
• Moon JS
• Seo JA
• Han K
• Kim NH

• KMID: 2560283
• DOI: http://doi.org/10.3803/EnM.2024.2020

Abstract

Background
We examined the impact of gout on the end-stage renal disease (ESRD) risk in patients with type 2 diabetes mellitus (T2DM) and determined whether this association differs according to chronic kidney disease (CKD) status.
Methods
Using the Korean National Health Insurance Service, this nationwide cohort study enrolled 847,884 patients with T2DM who underwent health checkups in 2009. Based on the presence of CKD (estimated glomerular filtration rate <60 mL/min/1.73 m²) and gout (two outpatient visits or one hospitalization within 5 years), patients were classified into four groups: CKD⁻Gout⁻, CKD⁻ Gout⁺, CKD⁺Gout⁻, and CKD⁺Gout⁺. Patients with incident ESRD were followed up until December 2018.
Results
Among 847,884 patients, 11,825 (1.4%) experienced progression to ESRD. ESRD incidence increased in the following order: 0.77 per 1,000 person-years (PY) in the CKD⁻Gout⁻ group, 1.34/1,000 PY in the CKD⁻Gout⁺ group, 8.20/1,000 PY in the CKD⁺Gout⁻ group, and 23.06/1,000 PY in the CKD⁺Gout⁺ group. The presence of gout modified the ESRD risk in a status-dependent manner. Hazard ratios (HR) were 1.49 (95% confidence interval [CI], 1.32 to 1.69) and 2.24 (95% CI, 2.09 to 2.40) in patients without and with CKD, respectively, indicating a significant interaction (P<0.0001). The CKD⁺Gout⁺ group had a markedly higher risk of developing ESRD (HR, 18.9; 95% CI, 17.58 to 20.32) than the reference group (CKD⁻Gout⁻).
Conclusion
Gout substantially enhances the risk of ESRD, even in the absence of CKD. Concurrent CKD and gout synergistically increase the risk of ESRD. Therefore, physicians should carefully screen for hyperuricemia to prevent progression to ESRD.

Keyword

Diabetes mellitus; Renal insufficiency, chronic; Kidney failure, chronic; Gout; Hyperuricemia

Figure

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  Fig. 1. Kaplan–Meier curve illustrating the incidence of end-stage renal disease (ESRD). CKD, chronic kidney disease.

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  Fig. 2. Forest plots of the subgroup analysis according to age, sex, diabetes duration, use of insulin and oral hypoglycemic agent (OHA). (A) Age, (B) sex, (C) diabetes mellitus (DM) duration, (D) use of insulin, (E) OHA <3. CKD, chronic kidney disease; HR, hazard ratio; CI, confidence interval.

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