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Gout patients should be regularly
assessed for the presence of nephrolithiasis as the risk of nephrolithiasis was
found to increase by 60% in both male and female gout patients.
A recent study revealed that the risk (age and sex adjusted)
of NL was increased by 60% in cases compared to controls. Increased risk of
nephrolithiasis (NL) is a very well-known complication of gout. Though there
are few comparative studies revealing the association of risk factors for NL in
gout. In this cohort study, scientists investigated:
(1) the overall incidence of NL in gout patients (cases) and the general
population (controls);
(2) risk and risk factors such as common co morbidities and medications for
first-time NL in cases and controls separately.
A total of 168,646 were included in the study out of these the cases were
n = 29,968 and age and sex-matched controls were n = 138,678. These all were
separately identified from the regional healthcare database in western Sweden
(VEGA). The analyzed risk factors like co morbidities and current medication
use for first-time NL and socioeconomic factors were extracted from VEGA and
other national Swedish registers. The follow up for cases, began on 1 January
2006 or the diagnosis of gout if this occurred later, and for controls follow
begun on their index patient's first diagnosis of gout. Follow up ended on
death, emigration or 31 December 2012. Both incidence rates (IR) per 1000
person-years and hazard ratios (HR) were calculated from the follow-up data. The
IR calculations were performed for cases (regardless of prior NL) and their
controls. HRs with the first occurrence of NL as the outcome were calculated
only in those without previous NL.
The NL events were 678 (IR: 6.16 events per 1000 person-years) in cases and 2125 (IR 3.85 events per 1000 person-years) in controls, resulting in an age-sex-adjusted incidence rate ratio of 1.60. But the point estimates for predictive factors were similar in both cases and controls, but losartan increased the risk of NL only in controls i. e., HR = 1.49. Loop diuretics were found to significantly decrease the risk of NL by 30-34% in both cases and controls. Further significant predictors of NL in gout cases were obesity, diabetes and male sex and in controls male sex and kidney disease.
Moreover, none of the commonly used medications increased the risk of NL in
gout patients.
Arthritis Research & Therapy
Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study
Landgren AJ et. al.
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