Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada.
Am J Kidney Dis. 2015 Jun;65(6):925-32. doi: 10.1053/j.ajkd.2015.01.017. Epub 2015 Mar 25.
In the general population, high serum uric acid concentration is a risk factor for gout. It is unknown whether donating a kidney increases a living donor's risk of gout as serum uric acid concentration increases in donors after nephrectomy.
Retrospective matched cohort study using large health care databases.
SETTING & PARTICIPANTS: We studied living kidney donors who donated in 1992 to 2010 in Ontario, Canada. Matched nondonors were selected from the healthiest segment of the general population. 1,988 donors and 19,880 matched nondonors were followed up for a median of 8.4 (maximum, 20.8) years.
Living kidney donor nephrectomy.
The primary outcome was time to a diagnosis of gout. The secondary outcome in a subpopulation was receipt of medications typically used to treat gout (allopurinol or colchicine).
We assessed the primary outcome with health care diagnostic codes.
Donors compared with nondonors were more likely to be given a diagnosis of gout (3.4% vs 2.0%; 3.5 vs 2.1 events/1,000 person-years; HR, 1.6; 95% CI, 1.2-2.1; P<0.001). Similarly, donors compared with nondonors were more likely to receive a prescription for allopurinol or colchicine (3.8% vs 1.3%; OR, 3.2; 95% CI, 1.5-6.7; P=0.002). Results were consistent in multiple additional analyses.
The primary outcome was assessed using diagnostic codes in health care databases. Laboratory values for serum uric acid and creatinine in follow-up were not available in our data sources.
The findings suggest that donating a kidney modestly increases an individual's absolute long-term incidence of gout. This unique observation should be corroborated in future studies.
在普通人群中，血清尿酸浓度升高是痛风的一个危险因素。目前尚不清楚捐肾后，随着供者血清尿酸浓度的升高，是否会增加活体供者患痛风的风险。
使用大型医疗保健数据库进行回顾性匹配队列研究。
我们研究了 1992 年至 2010 年在加拿大安大略省捐肾的活体供者。从一般人群中健康状况最佳的部分选择了匹配的非供者。对 1988 名供者和 19880 名匹配的非供者进行了中位随访 8.4 年（最长随访 20.8 年）。
活体供者肾切除术。
诊断为痛风的时间。亚组人群的次要结局是接受治疗痛风的典型药物（别嘌醇或秋水仙碱）。
我们使用医疗保健诊断代码评估主要结局。
与非供者相比，供者更有可能被诊断为痛风（3.4%比 2.0%；每千人每年 3.5 比 2.1 例；HR，1.6；95%CI，1.2-2.1；P<0.001）。同样，与非供者相比，供者更有可能开具别嘌醇或秋水仙碱的处方（3.8%比 1.3%；OR，3.2；95%CI，1.5-6.7；P=0.002）。在多项其他分析中，结果一致。
主要结局是在医疗保健数据库中的诊断代码中评估的。我们的数据来源中没有随访时血清尿酸和肌酐的实验室值。
研究结果表明，捐肾会适度增加个体患痛风的长期绝对发病率。这一独特的观察结果应在未来的研究中得到证实。
