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Kidney Week

Abstract: TH-PO159

Gout Severity in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Radeck, Lauren, Trinity Partners, Waltham, Massachusetts, United States
  • Mendonca, Clive M., Trinity Partners, Waltham, Massachusetts, United States
  • Lang, Isabel, Trinity Partners, Waltham, Massachusetts, United States
  • Kent, Jeffrey, Horizon Pharma, Lake Forest, Illinois, United States
  • Lamoreaux, Brian, Horizon Pharma, Lake Forest, Illinois, United States
  • Johnson, Richard J., University of Colorado Denver , Aurora, Colorado, United States
Background

Gout is a frequent co-morbidity of solid organ transplant (SOT), especially among kidney recipients. Less well understood are any differences in gout severity and treatment success between gout patients with and without SOT. This retrospective analysis of medical patient chart data was performed to compare disease severity and treatment history in recent gout case examples with vs. without a history of kidney transplant.

Methods

An online survey was completed using a panel of board certified U.S. nephrologists. Respondents were asked to pull de-identified patient charts for their 3 most recent gout patients. Measures evaluated included: SUA level, numbers of swollen/tender joints (at visit), visible tophi (at visit), gout flare events (prior 12 months), gout drug treatment history, and presence of “severe, uncontrolled gout” defined as: SUA ≥7.0 mg/dL, 1 or more visible tophi AND 2 or more gout flares, and history of xanthine oxidase inhibitor treatment. Case examples were weighted by number of visits in last 12 months and respondents’ overall gout treatment volume.

Results

23 out of 299 (7.7%) Rx-treated patients had a history of kidney transplant (N=104 nephrologist respondents). Compared to non-SOT patients, SOT patients were more likely to meet severe uncontrolled gout criteria (25% vs. 7%, p<0.05). Univariate analysis found that SOT patients, compared to non-SOT patients had: higher prevalence of visible tophi (32% vs. 13%, p<0.01), lower allopurinol treatment rates (28% vs. 50%, p<0.05), and higher rates of failure or contraindication to febuxostat (22% vs. 4%, p<0.01).

Conclusion

This study provides preliminary evidence that gout is more severe and poses more challenges for pharmacologic management in kidney transplant patients compared to other nephrology gout patients. Although gout has been linked to a higher all-cause mortality rate among kidney recipients in the literature, to our knowledge there are no published comparisons of gout severity among such patients vs. the general nephrology patient population. Further investigation of symptom severity and unmet need in appropriate, effective treatment options in transplant recipients with gout is warranted.

Funding

  • Commercial Support