The Incidence and Risk Factors of Gout in Non-dialysis Chronic Kidney Disease Patients With Asymptomatic Hyperuricemia.

Rationale & Objective: Gout frequently complicates chronic kidney disease (CKD), yet the incidence and specific risk factors for gout in patients with CKD and asymptomatic hyperuricemia remain unclear. We aimed to determine gout incidence and risk factors in nondialysis patients with CKD and asymptomatic hyperuricemia. Study Design: Retrospective cohort study. Setting & Participants: Analysis of 771 ambulatory nondialysis patients with CKD (stages 3-5) with asymptomatic hyperuricemia (serum urate level, ≥7.0 mg/dL), without prior gout, followed from 2010 to 2023 at a single center. Predictors: Multiple clinical and laboratory factors were evaluated, including demographics, comorbidities, medications, and biochemical markers. Outcomes: Incident gout diagnosis confirmed by rheumatology specialists. Analytical Approach: Cox proportional hazards models and receiver operating characteristic curve analyses. A composite weighted index was derived from regression-based predictors. Results: Over a median follow-up of 47 months, gout developed in 140 (18.2%) patients (incidence rate, 41.9 cases per 1,000 person-years). Independent predictors of gout included younger age (per year; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.96-0.99), higher serum urate (per 1 mg/dL; HR, 1.29; 95% CI, 1.14-1.46), lower serum creatinine levels (per 1 mg/dL; HR, 0.81; 95% CI, 0.65-0.99), and diuretic use (HR, 1.86; 95% CI, 1.00-3.45). Higher composite weighted index (per 1 unit; HR, 2.19; 95% CI, 1.70-2.83) was associated with increased gout risk. Limitations: Single-center, retrospective study design limits generalizability and causal inference. Conclusions: Incident gout is common among patients with CKD and asymptomatic hyperuricemia. Younger age, elevated serum urate levels, lower creatinine levels, and diuretic use significantly predict gout onset. Identifying high-risk patients using these predictors could guide preventive therapeutic decisions.