SAT0430 IMPACT OF GOUT ON ALL-CAUSE MORTALITY AMONG MEDICARE BENEFICIARIES WITH A HISTORY OF KIDNEY TRANSPLANTATION: A RETROSPECTIVE COHORT STUDY
Authors: LI Justin, Marissa Suh, Mark Brigham, Jeff Kent, Brian LaMoreaux, Richard J. Johnson, Brian Mandell, Nandini Hadker, Herman Sanchez, Kevin Francis, Gavin Miyasato
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Gout is a frequent comorbidity among kidney transplant recipients. A recent analysis estimated that 13% of kidney transplant receipients had an active diagnosis of gout. The clinical impact of comorbid gout in this population is not well understood, including if gout as a co-morbidity associates with higher mortality rates among kidney transplant recipients. <h3>Objectives</h3> This retrospective patient claims analysis was performed to determine whether an association between gout and mortality exists in the prevalent kidney transplant population. <h3>Methods</h3> A retrospective study using administrative claims from the Medicare fee-for-service (FFS) Limited Data Set (LDS) was conducted. Multivariable Cox proportional hazards regression assessed the relationship between gout and all-cause mortality. Given the ambiguity of the causal relationship between gout and comorbidities that make up the Charlson Comorbidity Index (CCI), three analyses were conducted assuming: 1) gout and certain comorbid conditions are associated by way of a common pathogenetic root, 2) gout is a precursor for developing these comorbid conditions, and 3) these conditions modify the effect of gout on mortality. <h3>Results</h3> Gout was associated with higher unadjusted risk of all-cause mortality (hazard ratio, HR: 1.44, 95% CI: 1.27-1.63). After adjusting for baseline demographics and time from transplantation, the HR risk with gout was attenuated but still statistically significant (HR: 1.16, 95% CI: 1.02-1.32). Further adjustment for baseline CCI found gout was not a significant risk factor (HR: 1.03, 95% CI: 0.90-1.17). Stratified models show gout among baseline CCI=0 score was associated with a 3.5-fold increased risk of all-cause mortality (HR: 3.48, 95% CI: 1.27-9.57). <h3>Conclusion</h3> The presence of gout was not an independent predictor of all-cause mortality among Medicare beneficiaries with a history of kidney transplantation. That gout in a subset of beneficiaries without baseline comorbidities was a predictor may suggest that gout serves as an early indicator of declining health in the larger prevalent kidney transplant population. Further research is needed to understand the relationship of gout and mortality in the kidney transplant population. <h3>References</h3> [1] Abbott KC, et al. Transplantation. 2005; 80(10):1383-1391. [2] Hernández-Molina G, et al. Transplantation. 2008; 86(11):1543-1547. [3] Brigham MD, et al. Arthritis Rheumatol. 2018; 70 (suppl 10). <h3>Disclosure of Interests</h3> Justin Li Consultant for: Horizon Pharma, Marissa Suh Consultant for: Horizon Pharma, Mark Brigham Consultant for: Horizon Pharma, Jeff Kent Shareholder of: Horizon Pharma, Employee of: Horizon Pharma, Brian LaMoreaux Shareholder of: Horizon Pharma, Employee of: Horizon Pharma, Richard J. Johnson Consultant for: Horizon Pharma, Brian Mandell Consultant for: Horizon Pharma, Nandini Hadker Consultant for: Horizon Pharma, Herman Sanchez Consultant for: Horizon Pharma, Kevin Francis Consultant for: Horizon Pharma, Gavin Miyasato Consultant for: Horizon Pharma