Rates of 5-year all-cause mortality and health care use are higher among patients with gout who also have chronic kidney disease, compared with those with only gout, regardless of age, according to findings published in BMC Rheumatology.
“Studies have shown that patients with gout have higher [health care resource utilization] than the general population and that the burden to the health care system is increasing,” Dena H. Jaffe, PhD, of Kantar Health, Ramat-Gan, Israel, and colleagues wrote. “In the United States, direct costs of gout were estimated as high as $18,362 per capita, gout-specific costs reaching $6,179 per person, and an annual estimated total burden of > $6 billion.”
“Studies show the increased health and cost burden of comorbidities and age on this relationship with regard to [health care resource utilization],” they added. “However, the specific contribution of each factor, such as [chronic kidney disease], which is highly prevalent among gout patients, is not fully understood.”
Rates of mortality and health care use are higher among patients with gout who also have chronic kidney disease, compared with those with only gout, according to findings.
To analyze the differences in health care use and mortality between those with chronic kidney disease and those without, among patients with incident gout, Jaffe and colleagues conducted a retrospective, population-based cohort study using day from Clalit Health Services, the largest health care payer in Israel. According to the researchers, the provider insures approximately 4.2 million citizens, including more than 60% of adults older than 65 years. Jaffe and colleagues examined 12,940 adults aged 25 years or older who were newly diagnosed with gout between Jan. 1, 2006, and Dec. 31, 2009, and followed for 5 years.
Among the included patients, 8,286 also had a pre-existing diagnosis of chronic kidney disease, chronic renal failure, kidney transplantation or dialysis at index date, while 4,654 did not. Patients were also stratified by age, with individuals younger than 55 years and those aged 55 years and older organized into subgroups. The researchers also reported on demographic and clinical characteristics, as well as health care use.
According to the researchers, patients with gout who also had chronic kidney disease demonstrated higher rates of health care use compared with those without. Total annual hospital admissions for patients with both gout and chronic kidney disease were at least three times higher for adults younger than55 years. However, admissions were about 1.5 times higher among patients aged 55 years and older without chronic kidney disease.
Rates of health care use from year 1 to year 5 remained similar across gout patients younger than55years regardless of chronic kidney disease status. Rates varied among patients aged 55 years and older according to chronic kidney disease status.
Patients with gout and chronic kidney disease demonstrated a higher 5-year all-cause mortality compared with those without chronic kidney disease, for both the younger (HR = 1.65; 95% CI, 1.01-2.71) and older (HR =1.5; 95% CI, 1.37-1.65) age groups.
“In light of the challenges facing clinicians to ‘cure’ gout, these findings provide critical evidence of differences between patient characteristics, healthcare utilization and outcomes of this at-risk sub-group over the course of the disease,” Jaffe and colleagues wrote. “Future work should explore factors associated with these outcomes and barriers to gout control such as annual [serum uric acid] testing and medication adherence, to better understand patient management by these subgroups.” – by Jason Laday
Disclosure: Jaffe reports employment with Kantar Health, which received fees from AstraZeneca for analysis and reporting. Please see the study for all other relevant financial disclosures.