New-onset gout after kidney transplantation: Incidence, risk factors and implications

Kevin C. Abbott, Paul L. Kimmel, Vikas Dharnidharka, Robert J. Oglesby, Lawrence Y. Agodoa, Sophie Caillard

Research output: Contribution to journalArticlepeer-review

69 Scopus citations

Abstract

Background. Although cyclosporine use has been associated with an increased risk of new-onset gout after renal transplantation, the incidence and risk factors for new-onset gout have not been reported in the era of modern immunosuppression. Methods. We conducted a retrospective cohort study of Medicare primary renal transplant patients reported in the United States Renal Data System (USRDS), using Medicare claims data to determine the incidence of new-onset gout. Cox regression analysis was used to calculate adjusted hazard ratios (AHR) for cyclosporine (including separate analysis of Neoral) compared directly with tacrolimus, for the risk of new-onset gout, adjusted for baseline demographic factors and posttransplant renal function. Results. The cumulative incidence of new-onset gout was 7.6% at 3 years posttransplant. The following factors were independently associated with an increased risk of new-onset gout: use of Neoral (vs. tacrolimus, AHR 1.25, 95% CI 1.07-1.47) at discharge, recipient male sex (AHR 1.44, 95% CI 1.25-1.67), older age, higher body mass index, and more recent year of transplant. No other immunosuppressive medications were associated with new-onset gout. Diabetes was associated with a significantly lower risk of new-onset gout. The development of new-onset gout was independently associated with decreased patient survival (AHR 1.26, 95% CI 1.08-1.47) as well as death-censored graft survival. Conclusions. Cyclosporine is an independent risk factor for new-onset gout after transplantation. The incidence of new-onset gout appears to be increasing even while the use of cyclosporine is decreasing, and the development of new-onset gout was an independent predictor for death and graft loss in this population.

Original languageEnglish
Pages (from-to)1383-1391
Number of pages9
JournalTransplantation
Volume80
Issue number10
DOIs
StatePublished - Nov 1 2005

Keywords

  • Age
  • Body mass index
  • Creatinine
  • Cyclosporine
  • End stage kidney disease
  • Glomerular filtration rate
  • Kidney transplant
  • Medicare claim
  • New-onset gout
  • Obesity
  • USRDS

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