Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
The association between gout and nephrolithiasis: The National Health and Nutrition Examination Survey III, 1988-1994

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Abstract

Background: Gout, an inflammatory arthritis, reportedly afflicts more than 2 million men and women in the United States. Previous reports have suggested an association between gout and kidney stone disease; however, these studies did not adjust for such important potential confounders as obesity and the presence of hypertension. To our knowledge, no published study has examined the independent association between gout and kidney stone disease. Methods: We used a national probability sample of the US population to determine the independent association between reported gout and history of kidney stone disease. Results: Among men and women 20 years and older, 5.6% (10 million) reported the previous passage of a kidney stone and 2.7% (5.1 million) reported a diagnosis of gout by a physician. Moreover, 8.6% of individuals who reported the passage of a kidney stone on two or more occasions had a history of gout. Conversely, the prevalence of previous kidney stones in subjects with reported gout was 13.9%. In the age-adjusted model, gout was associated with an increased odds ratio (OR) for previous kidney stones (OR, 1.97; 95% confidence interval [CI], 1.37 to 2.83). After further adjustment for sex, race, body mass index, and presence of hypertension, the OR for previous kidney stones in individuals with gout decreased to 1.49 (95% CI, 1.04 to 2.14). Conclusion: Showing an independent association between kidney stone disease and gout strongly suggests that they share common underlying pathophysiological mechanisms. Identification of these mechanisms may lead to improved preventive strategies for both conditions. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Study population

We used data from the Third National Health and Nutrition Examination Survey (NHANES III). The NHANES III was designed to be a probability sample of the total civilian noninstitutionalized population aged 2 months or older in the United States and collected health and nutritional data on 33,994 men, women, and children from 1988 to 1994. Certain subgroups were oversampled, such as young children, older persons, non-Hispanic blacks, and Mexican Americans. Details of the survey design may be

Results

The age range in the population was 20 to 90 years, 52.4% were women, and 47.6% were men. The diagnosis of gout by a physician was reported by 3.8% of men and 1.6% of women (2.7% of the total population). Overall, 5.6% reported the previous passage of a kidney stone (6.9% of men, 4.3% of women), and 26.3% of these subjects had passed a kidney stone on two or more occasions. Characteristics of the US population by history of kidney stones are listed in Table 1.

. Characteristics of the US

Discussion

In this nationally representative sample of men and women, the frequency of kidney stone disease in subjects with gout was almost threefold greater than that in the general US population. After adjusting for potential confounders, including age, sex, and BMI, we found that a history of gout was associated with a 49% increase in risk for previous kidney stones. In 1967, Yu and Gutman8 reported a history of kidney stones in 22% of 1,258 patients with primary gout. This is approximately 50%

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Supported in part by grant no. DK59583 from the National Institute of Health (G.C.). H.M.K. is an American Kidney Fund Clinical Scientist in Nephrology Fellow.

Address reprint requests to Gary Curhan, MD, ScD, Channing Laboratory, 181 Longwood Ave, Boston, MA 02115. E-mail: [email protected]

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