Abstract: SA-PO0473
Changes in Gout Management and Outcomes After Referral from Primary Care to Nephrology: A Retrospective Claims Analysis
Session Information
- CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- LaMoreaux, Brian, Amgen Inc., Thousand Oaks, California, United States
- Zhang, Tingting, Amgen Inc., Thousand Oaks, California, United States
- Mende, Christian W., University of California San Diego School of Medicine, La Jolla, California, United States
- El-Meanawy, Ashraf, Kidney Disease Center & Cardiovascular Center, Milwaukee, Wisconsin, United States
Background
Gout is common in patients with chronic kidney disease (CKD) and frequently encountered in nephrology practice. Guideline-concordant gout care includes serum urate (SU) monitoring and urate-lowering therapy (ULT), but effective management may be challenging in patients with CKD and multimorbidity. Most gout care occurs in primary care, and the impact of referral to nephrology on gout management and outcomes remains poorly described.
Methods
Using Optum's de-identified Clinformatics® Data Mart Database (2016-2025), we identified adults who met a claims-based gout case definition and were diagnosed by primary or emergency physicians. The first nephrologist visit was the index date. Patients must have had one year of continuous enrollment pre-index and two years post-index and have met the gout case definition before the pre-index year. Outcomes were assessed in sequential 6-month intervals pre- and post-index, and included gout flares, gout-related emergency department (ED) visits, oral ULT prescribing, average oral ULT dose, and proportion of days covered (PDC).
Results
Among 2,765 patients, mean age was 73 years, 64% were male, and 84% had CKD. Comorbidity burden was high, including hypertension (52%), hyperlipidemia (78%), and diabetes (51%). SU testing increased from 50% in the immediate pre-index interval to 57% in the first 6 months post-index, while oral ULT prescribing increased from 65% pre-index to 71%. Mean oral ULT fills per patient and mean sUA tests per patient remained stable from pre- to post-index. Gout flares peaked 6 months post-index (18%) and declined over time to 9%, 18-24 months post-index. Gout-related ED visits dropped from 1.7% to 0.9%, and oral NSAID prescriptions dropped from 9% to 7% from pre- to post-index, whereas mean daily doses of allopurinol (~195 mg pre- to post-index) and febuxostat (48mg) and mean PDC for both products (55% to 61%) remained largely stable.
Conclusion
Referral from primary care to nephrology represents a potentially important touchpoint to improve gout care in patients with high comorbidity burden, particularly CKD. Following referral to nephrology, increases in gout management measures and improvements in gout-related outcomes were observed. Additional efforts to strengthen gout management in nephrology practice may further improve outcomes.
Funding
- Commercial Support – Amgen Inc.