Incidence and Risk Factors of Gout in Nondialysis-Dependent Patients with CKD and Asymptomatic Hyperuricemia

Background: The association between asymptomatic hyperuricemia and the development of gout in chronic kidney disease (CKD) patients in stages 3-5 who are not yet on dialysis has not been fully investigated. This study aimed to assess the prevalence of gout in this population and identify risk factors for its development. Methods: A retrospective analysis of a clinical database of ambulatory CKD patients without dialysis who had asymptomatic hyperuricemia and no prior history of gout was conducted. The study period was from 2010 to the present. Gout diagnoses confirmed during the follow-up period were based on the Rome criteria and were confirmed by the institution's rheumatology clinic. Results: This study included 771 CKD patients in stages 3-5 without dialysis, with an average age of 72 years, of whom 44% were women. Over a median follow-up period of 47 months, 18% of the patients developed gout. Analysis using a Cox proportional hazards model with backward conditional elimination identified four independent risk factors for gout: age, diuretic use, uric acid levels, and creatinine levels. Cutoff points for continuous variables were determined based on ROC curve analysis, and then these risk factors were combined into a scoring system based on multivariate logistic regression coefficients. This system allowed for the estimation of gout risk and showed a hazard ratio (HR) of 2.25 (95% CI: 1.60-3.16) for CKD patients under 71 years of age who use diuretics regularly, have uric acid levels above 8.3 mg/dL, and creatinine levels below 1.5 mg/dL. This association remained significant even after adjustment for multiple variables, including the Charlson Comorbidity Index and BMI. Conclusion: Gout prevalence is high among CKD patients with asymptomatic hyperuricemia. Early treatment aimed at lowering blood uric acid levels may be beneficial for high-risk populations. These findings warrant further validation through interventional studies.