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Original Article Impact of Chronic Kidney Disease and Gout on End-Stage Renal Disease in Type 2 Diabetes: Population-Based Cohort Study
Inha Jung1*orcid , Da Young Lee1*orcid , Seung Min Chung2, So Young Park1, Ji Hee Yu1, Jun Sung Moon2, Ji A Seo1, Kyungdo Han3orcid , Nan Hee Kim1orcid

DOI: https://doi.org/10.3803/EnM.2024.2020 [Epub ahead of print]
Published online: August 30, 2024
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1Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
3Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
Corresponding author:  Kyungdo Han, Tel: +82-2-2258-7226, Fax: +82-2-532-6537, 
Email: hkd917@naver.com
Nan Hee Kim, Tel: +82-31-412-4274, Fax: +82-31-412-6770, 
Email: nhkendo@gmail.com
*These authors contributed equally to this work.
Received: 23 April 2024   • Revised: 19 June 2024   • Accepted: 2 July 2024
contributed equally to this study as co-first authors.
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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.

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