III. Gout after living kidney donation: Correlations with demographic traits and renal complications
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- Please summarise this article in your own words
- What is the level of evidence provided by this article?
- Please reflect on the guidelines and refer to your practice.
Thank you All for your replies
There are obvious limitations of this study. What are these limitations?
-There is a lack of baseline data on clinical factors such as body mass index
– There is a lack of information on the laboratory results in serum uric acid levels and post-donation serum creatinine and dietary practices.
-the race information for non-donor was not known.
-The information provided on pre-donation diagnoses was not sufficient enough to be included.
I note the limitations of this study highlighted by you, dear Dr Waem.
The limitations of this study included non-capturing of uninsured donors, inadequate pre-donation diagnoses data,
1- Lack of clinical data ( BMI and laboratory)
2- Lack of race data of the non-donors,
3- The number of physician visits were not included in the data-set.
The study supports the need for long-term follow-up and access to healthcare to all donors.
I note the limitations of this study highlighted by you, dear Dr Wadi.
Thanks alot Prof.Sharma
Limitation to the study was is that, study was limited to insurance donors and is not involve the uninsured living donors.
Pre donation benefits was captured for only a minority of the donors , and depleted information of having a predonation gout.lack of clinical data for donors .
Lab rotary data such as serum uric acid, dietary habits, alcohol intake, over the counter medication, were not available .
I note the limitations of this study highlighted by you, dear Dr Kamal.
The limitations;
1-Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
2-The study lacked baseline information on clinical parameters such as body mass index sufficient for inclusion .
3- The study outcome definition of a diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals, and may be subject to misclassification.
I note the limitations of this study highlighted by you, dear Dr Ishag.
Limitations:
That is a very good analysis. I note the limitations of this study highlighted by you, dear Dr Huda.
thank you
That is a very good analysis. I note the limitations of this study highlighted by you, dear Dr Omar.
That is a very good analysis, dear Dr Yusuf.
Limitations of the study:
1. Relied on administrative data from a private insurance
plan, and thus, uninsured living kidney donors are not captured.
2. Pre-donation benefits were captured for only a minority of the
donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
3. Lacked baseline information on clinical parameters such as body mass index sufficient for inclusion, and the OPTN does not collect information on
gout baseline gout history.
4. Laboratory values, such as serum uric acid levels and post donation serum creatinine, and information on dietary habits, alcohol intake, and over-the counter medication use were not available in the data sources.
5. The outcome definition of a diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals, and may be subject to misclassification.
6. Did not account for the number of physician visits in follow-up.
7. Race information was not available for non-donors
That is an excellent analysis. I note the limitations of this study highlighted by you, dear Dr Ashmaig.
Thanks Prof Ajay
*The accounting data from a private insurance plan, so that uninsured living kidney donors are not taken.
*Pre-donation benefits were gained for a minority of the donors, and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
*lacked baseline information on clinical parameters such as body mass index
* Laboratory estimates, such as serum uric acid levels and post-donation serum creatinine, and information on dietary habits, alcohol intake, and over-the-counter medication use were not available in the data sources.
*No account for the number of physician visits in follow-up.
*Race information was not available for non-donors.
Thank you
The study had several limitation which included:
Thank you
Thank you
Limitation of this study no available information on race .,75% are Caucasian ,so these result may not be generalized to non-Caucasian donors.
Thank you, Manal. There are more limitations than this.
Study limitations:
Thank you
Limitations:
uninsured living kidney donors are not captured.
Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
lacked baseline information on clinical parameters such as body mass index sufficient for inclusion (available for only 5.3% of the sample). The OPTN does not collect information on gout baseline gout history.
Laboratory values, such as serum uric acid levels and post-donation serum creatinine, and information on dietary habits, alcohol intake, and over-the-counter medication use were not available in our data sources.
definition of a diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals, and may be subject to misclassification.
no account for the number of physician visits in follow-up.
race information was not available for non-donors.
Thank you Maksuda
Limitation of the study.
-Selection bias as non-insured donors not concluded.
-Information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
-lacked baseline information on clinical parameters such as body mass index sufficient for inclusion.
-Lack of laboratory values, such as serum uric acid levels and post-donation serum creatinine.
-Lack of information on dietary habits, alcohol intake, and over-the counter medication.
-The number of physician visits in follow-up was not accounted.
-Race information was not available for non-donors
Thank you
Its a retrospective study that censored the occurrence of Gout in kidney donors, dependent on the data provided by insurers billing claims. They found that its incidence is higher in African american , men and the elder donors. furthermore , donors diagnosed with gout were at increased risk of renal adverse events such as acute renal failure.
few limitations lingered in this study as follows:
1} The patients cohort involved only the insured patients, non insured were not included, as the data base of the patients were entirely dependents on private insurer records and plans.
2}The pre-donation features of the donors are non available to compare and instigate the risk factors for developing gout, such as the incidence of Gout pre donation is non existent for majority of donors and therefore was not categorized in the study.
3}Similarly, the other features of the donors such as body mass index and other clinical parameters were inadequate to be included in the study.
4}There is no data on baseline gout history .
5} No data about history of gout was available due to the data source dependent by the study.
6} The diagnosis of gout was based on billing data, and not on medical records and physicians visits
7} There is no reports of creatinine and uric acid parameters post donation.
8} For the same reason of deficient and limited source of data, There was significant information deficiency about the risk factors integral to the development of Gout, such as , dietary habits, alcohol intake and over the counter medications use.
9}The diagnosis was dependent on billing claims and not the aspiration of synovial fluids for mono sodium urate which is the gold standerd for diagnosing Gout. Which cast a hue of dissatisfaction on the accuracy of the diagnosis.
10} Race information was not available for non donors, which is an important factor that might affect the outcome as 13 % of the donors are african americans.
Thank you
Limitations
The limitations of the study included non-capturing of uninsured donors, inadequate pre-donation diagnoses data, lack of clinical data like BMI, lack of racial data of the non-donors, the number of physician visits were not included in the data-set.
I agree with my colleague regarding the medications but want to add:
I could not find the evaluation of other confounding factors like medications; simply a thiazide of thiazide-like diuretics may be an additive cause. recordings may have missed other patients who used gout prophylactic attack treatment. to simplify: In Turkey, I am not obliged to enter the ICD-code of gout for Allopurinol, CKD is enough. this is not the same for colchicine for example.
Limitations:
1. gouty diagnosis criteria are not clear
2. pre-donation history of gouty, laboratory, and clinical parameters are not clear
3. non-donors control group is from the general population.
Hyperuricemia ia a known risk factor of CKD development & progression. Several meta-analysis found that high level of uric acid is an independent predictor of new cases of CKD in non CKD population.
Aims of the study:
This is a retrospective study, use the donor information from OPTN data (Oct 1987-Jul 2007). Non donors enrolled in same insurance benefit plan during the same period sample considered as general population control.
Result & discussion:
Limitations :
Retrospective study, level 3.
Long follow up of serum uric acid in live donors is essential for early detection & treatment of gout to reduce incidence of CKD among donors especially elderly & AA donors.
Retrospective study.
Non insured donors not included .
Result based on prescription of drugs not on joint fluid aspiration or serum uric acid.
Control the entire donor population.
Pre-donation diagnoses, such as gout, was not adequate for inclusion.
Lacked baseline information, Laboratory values, such as serum uric acid levels and post
donation serum creatinine, and information on dietary habits, alcohol intake, and over-
the counter medication use were not available.
The control group was restricted to those with health insurance, thus not being able to assess the population without coverage. We had no data on lifestyle, diet, alcohol consumption, and additional medications, and the diagnosis was restricted to the registration or use of medications, with no additional diagnostic findings.
The limitation of the study is based on how the data was collected as it relates to the donor status before donation if there was any gout, the donor’s BMI, their diet, and no blood studies to confirm the same.
Limitations of the study
· data obtained from a private insurance plan, and thus, uninsured living kidney donors are not included
· Pre-donation benefits were captured for only a minority of the donors, and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion
· Some laboratory and habitual data are not available in data sources
· diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals
· race information was not available for non-donors
This retrospective cohort study analyzed possible correlations of gout with demographic traits and renal disorders after donation.This study included 4650 living kidney donors from May 2000 to Dec 2007.Follow up period was around 4.9 & 7.7 years
Results.
Demographic Correlates of Gout after Living Kidney Donation.
African-American ,elderly male donors have increased incidence of gout. Post-donation renal conditions (AKI- (rate ratio 12.5), CKD- (rate ratio 5.0), & others)were more common in donors with gout compared to those without gout.Major limitation of the study included no detailed clinical information and laboratory parameters mentioned in the study.Number of physician visits also not included.
Retrospective Cohort study-level III
At our center, Donors are being counseled in detail about the chances of gout after donation and those who high chance or in whom gout have occurred before are advised to adopt life style changes and ways to decrease future occurrence.
Ø U.S. living kidney donors (1987-2007): sample of 4,650 donor
Ø post-donation gout based on medical diagnosis while The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. And also compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race
Ø 4,650 donors included 13.1% African-Americans who were almost twice as likely to develop gout as Caucasian donors (4.4% vs. 2.4%; adjusted hazard ratio, aHR, 1.8; 95% confidence interval, CI, 1.0–3.2).
Ø Post-donation gout risk also increased with older age at donation (aHR per year 1.05) and was higher in men (aHR 2.80).
Ø Gout rates were similar in donors and age- and sex-matched general non-donors (rate ratio 0.86, 95% CI 0.66–1.13). Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure (rate ratio 12.5; 95% CI 1.5–107.0), chronic kidney disease (rate ratio 5.0; 95% CI 2.1–11.7), and other disorders of the kidney (rate ratio 2.2; 95% CI 1.2–4.2).
Ø Donor subgroups at increased risk of gout include African-Americans, older donors, and men.
Level 3
Please reflect on the guidelines and refer to your practice.
Gout screening in follow up visits specially for older male donor.
It is a retrospective cohort study with level 3 evidence to study the association of living kidney donor with gout among the living kidney donors who had donated between October 1987 and July 2007 and were enrolled in the insurance benefit plan at some point after donation during May 2000 to December 2007.The study sample of 4,650 donors included 13.1% African-Americans. By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors (4.4% vs. 2.4%; adjusted hazard ratio, aHR, 1.8; 95% confidence interval, CI, 1.0–3.2). Post-donation gout risk also increased with older age at donation (aHR per year 1.05) and was higher in men (aHR 2.80). Gout rates were similar in donors and age- and sex-matched general non-donors (rate ratio 0.86, 95% CI 0.66–1.13). Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure (rate ratio 12.5; 95% CI 1.5–107.0), chronic kidney disease (rate ratio 5.0; 95% CI 2.1–11.7), and other disorders of the kidney (rate ratio 2.2; 95% CI 1.2–4.2).
The limitations include relied on administrative data from a private insurance plan, and thus, uninsured living kidney donors are not captured. Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion. Laboratory values, such as serum uric acid levels and post donation serum creatinine, and information on dietary habits, alcohol intake, and over the counter medication use were not available in the data sources. In conclusion, donor subgroups at increased risk of gout include African Americans, older donors, and men.
This a retrospective observational cohort study ( level 3 evidence)
it includes more than 4000 donor
the aim to assess the risk factors of developing hyperuricemia and it impact on kidney function
they found that is more frequent in old age donor, males with higher tendency to start the treatment and a higher perden to developing kidney disease
This retrospective cohort study included living kidney donors who had donated between October 1987 and July 2007 and were enrolled in the insurance benefit plan at some point after donation during May 2000 to December 2007 (the period of available claims data).
The Persons who had not donated a kidney (non-donors) were enrolled in the same insurance benefit plan at some point during the same time (May 2000 to December 2007) were sampled as general population controls.
All study participants were simultaneously enrolled in medical and pharmacy benefits with the insurer exclusively during the study period.
The study found that African Americans had nearly twice the likelihood of post-donation gout diagnosis or treatment as Caucasians after adjustment for age and sex (4.4% versus 2.4% at seven years).
Gout was also more common among older and male donors, consistent with patterns observed in the general population and in a recent Canadian study of living kidney donors
The study found that reduced rate of gout among living donors compared to general non-donors that was limited to donors with earlier study capture in relation to donation risk of gout dissipates with time after donation.
Donors with gout had a higher burden of renal diagnoses after donation compared to matched donors without gout.
Lower incidence of gout among living donors compared to general non-donors that was limited to donors captured earlier in the study data in relation to donation, suggesting that a protective effect of medical screening and selection on risk of gout dissipates with time after donation.
When living kidney donors were compared to non-donors selected for similar baseline health in Ontario, their risk of gout appears to be higher supporting that surgical GFR reduction is relevant to uric acid metabolism and associated clinical consequences.
When donors with gout were compared to donors without gout, there were significant increases in the rates of post-donation renal conditions, such as acute kidney injury, CKD, and other disorders of the kidney.
Limitations
Conclusion
The donor subgroups at increased risk of gout include African Americans, older donors, and men. Donors have lower gout rates than general-population non-donors early after donation but similar rates during later observation, suggesting that an initial protective effect of medical evaluation and selection on gout risk dissipates with time after donation.
Donors with gout also appear to have a higher burden of post-donation renal complications after demographic adjustment.
What is the level of evidence provided by this article?
Leve II
The hyperuricemia has been seen in our clinical practice but incidence of gout has been low. Some centers in Malaysia opted to start allopurinol in hyperuricemia but our Centre do not believe in reduction of uric acid reduces incidence of CKD
Hyperuricemia ia a known risk factor of CKD development & progression. Several meta-analysis found that high level of uric acid is an independent predictor of new cases of CKD in non CKD population.
Aims of the study:
This is a retrospective study, use the donor information from OPTN data (Oct 1987-Jul 2007). Non donors enrolled in same insurance benefit plan during the same period sample considered as general population control.
Result & discussion:
Limitations :
Retrospective study, level 3.
Long follow up of serum uric acid in live donors is essential for early detection & treatment of gout to reduce incidence of CKD among donors especially elderly & AA donors.
This is a retrospective cohort study that included 4,650 living kidney donor who had donated between October 1987 and July 2007, and age- and sex-matched general non-donors. The incidence of gout was 2.5% in the donors. African American has 4.4% and Caucasian has 2.4% risk by 7 years. the primary outcome was similar in Hispanic donors and Caucasian donors. The risk of a diagnosis of gout or a pharmacy fill for a gout medication rose by 5% with each increase in year of donor age. Post-donation gout was almost 3 times higher among male compared to female donors and males are 5 times more tendancy than females to receive a medication for gout . The most significant risk factor is age with each increase in year of donor age resulting in a 6% increase in risk of a gout diagnosis and a 5% increase in risk of receiving a medication for gout. The incidence in donors is 16.0 per 1000 person-years compared with 18.6 per 1000 person in the age- and sex-matched non-donors.
level of evidence is II
kdigo recommends informing donors that their serum uric acid increase with rising creatinine and it is related to their baseline levels
Limitations include
Criteria of gout diagnosis are not clear
Pre-donation history of gout, lab testing, and clinical items are not clear
Control group is from the general population.
INTRODUCTION
Many kidney donor candidates have a history of prior symptomatic kidney stones and as many as 11% have evidence of stones on renal imaging performed during the evaluation. Some data suggest that kidney stones may be associated with a higher risk of CKD and ESKD. In one study from Canada, one or more episodes of kidney stones were associated with a twofold higher risk of ESKD. A National Health and Nutrition Examination Survey based study also reported that a history of kidney stones was associated with CKD and ESKD in women but not in men.
Kidney donors with stones, whether occurring pre- or post- donation, were not at a higher risk for developing hypertension, reduced eGFR, proteinuria, or ESKD. A majority of kidney stones occurred in older Caucasian donors who were unrelated to the recipient and who were also more likely to have a lower eGFR at donation. Notably, very few donors reported kidney stones after donation. These findings, however, do not provide guidance on candidates with more complicated stone history as those have been generally excluded from donation.
Symptomatic and incidentally discovered kidney stones in kidney
donors are not uncommon; 3%–11%.The lower rate of stones in this cohort may reflect the practice of excluding donors with stones from donation and perhaps a consequence of the more sensitive radiological assessment employed in donor evaluation in recent years.
Kidney donors do not appear to be at a higher risk for kidney
stones after donation. Thomas et al showed that kidney donors had similar hospital encounters for kidney stones as non-donor controls. Moreover, over a median follow-up of 8.4 years, the rate of kidney stones needing surgical intervention was similar, 9/10 000 persons-years, in donors controls. These findings are consistent with the very few stones reported here in RELIVE donors after donation. Certainly, the low rates of post-donation stones might be related to screening-out candidates who were deemed to have a high stone recurrence potential at the time of donor evaluation in addition to the general recommendation given to kidney donors to stay “well hydrated”.
These findings were echoed by a study of individuals with former kidney stone(s) in Olmsted County, Minnesota which partially overlapped the RELIVE study period (1984–2012). ESKD development in their cohort was rare (0.93% in stone formers vs. 0.36% in non-stone formers) after a mean follow-up of 12 years.
It is possible that studies demonstrating an association between stones and CKD in the general population are highly confounded by the presence of predisposing factors that are almost always absent in kidney donors, as kidney donors rarely have comorbidities, have no evidence of even subtle renal disease, are generally on no medications, and have normal weight in the majority of cases. Moreover, we are unaware of ESKD cases in kidney donors that were attributed to kidney stones.
We propose that donor candidates should not be excluded from
donation for having kidney stones as long as they are carefully evaluated for underlying metabolic disturbances most of which are amenable to dietary and/or pharmacological interventions. Furthermore, we believe that excluding donors with multiple kidney stones, particularly remote ones, who have a benign urinary profile should be revisited and studied further.
In all, these data suggest that kidney donors with kidney stones
who were allowed to donate do not have an increased risk of reduced eGFR, hypertension, or proteinuria when compared to kidney donors with no kidney stones. We believe that excluding donors with any kidney stones by 25% of US transplant centers may not be justified.
Evidence III
Please summarize this article in your own words
Aim: assess the correlations of kidney donation and gout.
Methods:
This is a retrospective study done in the USA.
Sample size: 4650 donors. Data collected from national living donor registry from 1987-2007.
Gout after kidney donation was studied in correlation to demographic and medical variables from data collected from the registry. Comparison of results between donors with gout and donors without gout.
Results:
Gout was more common in donors with African American origin compared to Caucasian origin (4.4% vs 2.4%). Gout was higher in older donors (a-HR/year 1.05), and higher in male donors (a-HR 2.8). the above-mentioned groups are more liable to develop renal disorders after kidney donation.
Donation doesn’t increase the risk of developing gout after kidney donation because there was no difference between donor and non-donors.
Limitations:
1- Uninsured living donors were not included in this study.
2- Pre-donation data were not included in the study.
3- Post donation data regarding serum urate level, renal function tests, dietary habits, alcohol intake and over the counter medications were not recorded in the data registry.
What is the level of evidence provided by this article?
Level III.
Please reflect on the guidelines and refer to your practice.
During pre-donation counselling, donors should be re-assured that donation doesn’t increase the incidence of gout compared to non-donors.
In some groups of donors especially of African origin, older age and male donors, so post donation follow-up of serum urate and renal function tests are recommended.
Introduction
Renal impairment is associated with further decrease uric acid excretion and elevated levels of serum uric acid, as well as potential higher risk of gout in CKD patients. It is known that raised serum uric acid levels is regarded as a considerable risk factor for the development and progression of CKD. Recent studies elaborated that hyperuricemia is an independent predictor of newly diagnosed CKD in the non-CKD population.
Recent studies discovered that serum uric acid levels commonly rise more than pre-donation values as early as 6 months post donor nephrectomy. New studies assessing living renal donors observed that frequent diagnosis of gout as well as the subsequent need for anti-gout medications in comparison to healthy matched non-donors within estimated 8 years follow-up interval.
African-Americans have a higher risk of gout compared to Caucasians based on the general population. This was primarily due to the encountered higher serum uric acid levels, more hypertension, and greater use of diuretics.
Post-donation can cause hyperuricemia as well as predisposes to gout, with the mixed interplay between uric acid and renal function, it might be reasonable to suggest that hyperuricemia contributes to renal disease post-donation.
One study involved 207 women concluded that female living renal donors suffered a 60 μmol/L increase in pre-donation serum uric acid level was correlated to 1.7-times higher risk of >25% decline in estimated glomerular filtration rate (GFR) at 6 months post-donation.
The target of this project is to identify post-donation gout and to investigate possible variations within donors according to demographic traits including race. Establishment of associations between gout and kidney disease was another aim of this study, so we compared rates of renal situations among matched donors with and without gout.
Methods
The study design was retrospective cohort study, involved living renal donors in the time between October 1987 and till the end of 2007.
Outcomes
Identifying possible correlations of gout with renal disorders post donation. Important demographic information at the time of donation included age, sex, and race.
Statistical analyses
P-values <0.05 were considered statistically significant.
Results
Baseline Characteristics of the Living Donor Sample
The study population was 4,650 living kidney donors resembling the US population. The donors were: 76.3% Caucasian, 13.1% African-American, 8.2% Hispanic, and 2.4% other races. The proposed mean age at donation time was 37.2 years with 45% were men.
Percentage of related renal living donors was 81.2% which were biologically related. The elapsed time from donation till end of observation is about 4.9 up to 7.7 years.
Demographic Correlates of Gout after Living Kidney Donation
The seven-year incidence of gout was nearly twice as common among African-American compared to Caucasian donors (4.4% vs. 2.4%; HR 1.8; 95% CI 1.0-3.2; P=0.04).
The risk of a diagnosis of gout was elevated by 5% with each increase in year of donor age (HR 1.05; 95% CI 1.03-1.07; P<0.0001). Post-donation gout was almost three times higher among male compared to female donors (aHR 2.80; 95% CI 1.75-4.48; P<0.0001).
Comparison of Gout in Living Donors and General Non-Donors
Incidence of gout occurrence by rate of 16.0 per 1000 person-years in living renal donors versus statistically similar rate of 18.6 per 1000 person-years in the age- and sex-matched non-donors (rate ratio 0.86; 95% CI 0.66-1.13). Also, the diagnosis of gout was found to be more common among men rather than women in both donors and non-donors.
Unfortunately, gout rates were greater among donors captured later after nephrectomy, leading to statistically close rate ratios for both donors and non-donors (1.15, 95% CI 0.81–1.63). In addition to the demonstration of similar patterns of lower rates of gout diagnoses or treatment were observed among donors captured earlier versus later after donation.
Correlations of Gout and Renal Conditions after Living Donation
Donors with gout (n=103) according to this study showed more frequent post-donation renal diagnoses versus donors without gout. Highlighting the presence of statistical significance for acute kidney failure (rate ratio 12.5; 95% CI 1.5–107.0), CKD (rate ratio 5.0; 95% CI 2.1–11.7), and other disorders of the kidney (rate ratio 2.3; 95% CI 1.2–4.2).
Discussion
The striking conclusion was that African-Americans had nearly twice the likelihood of post-donation gout diagnosis or treatment as Caucasians after adjustment for age and sex (4.4% versus 2.4% at seven years). The incidence of gout was also more common among older and male donors, consistent with patterns observed in the general population. Also, it seemed that donors with gout suffered renal diagnoses after donation more than matched donors without gout.
The prevalence of gout is expanding with more particular concern in the elderly and in patients with CKD. Decline of renal function can lead to elevated serum uric acid levels and subsequent increased risk of gout (10-year incidence gout is estimated to be 49% for uric acid levels ≥9 mg/dL vs. 1% for uric acid levels <7.0 mg/dL).
One recent pilot study discovered that higher pre-donation serum uric acid was linked to more GFR reductions at 6 months post-donation among women.
Limitations could be due to ignoring racial differences in renal risk are likely multifactorial and influenced by racial variation in the onset of comorbidities such as hypertension and diabetes after donation. Lack of some baseline information on clinical parameters such as body mass index was also a drawback. Laboratory values, such as serum uric acid levels and post-donation serum creatinine, and information on dietary habits, alcohol intake, and over-the-counter medication use were unavailable as well.
The definition of a diagnosis of gout was not based on joint fluid aspiration. The deficient race information for non-donors is also a disadvantage of the study.
The strength of this study is regarded as being the first to assess racial variation in the risk of gout in living kidney donors. It ensured the urging need for long-term post-donation follow-up and healthcare support for all donors.
Conclusion:
They pointed to different donor subgroups at increased risk of gout include African-Americans, older donors, and men.
The other important conclusion was that donors have lower gout rates than general-population non-donors early after donation but similar rates during later observation.
Donors with gout suffer more post-donation renal complications.
Level of evidence III.
Our centre practice, recommends follow up of living renal donors with full renal assessment and imaging if required. Adopting healthy lifestyle as well as dealing with any health issue that might affect his condition in a prompt manner.
Introduction;
Nephrectomy is associated with loss of about 30% of the renal function. Hence, uric acid level in the blood tend to accumulate resulting in the development of gout. Similarly, high level serum uric acid has been associated with development and progression of CKD among kidneys donors.
Aim:
To identify the development of gout post donation and possible variation among donors using demographic traits.
To compare the occurrence of gout among living kidneys donors and general population
To compare the rate of development of kidney disease among donors with and without gout
Method
This is a retrospective cohort study which used linked healthcare databases in the U.S. It included 4650 between October 1987 to July 2007. case and control were matched for age and sex.
Results
The study sample included 76.3% Caucasian and 13.1% African-Americans.
By seven years, the cumulative incidence of gout the donor sample was 2.5%.
African-Americans were almost twice as likely to develop gout (due to precipitating factors such as; hyperuricemia, HTN, Diuretic use, and CKD) compared to Caucasian donors (4.4% vs. 2.4%)
Post-donation gout risk increased with older age at donation as well as male sex
Living donor and non-donor with the same health condition had higher incidence of gout.
Donors with gout have a higher burden of post-donation renal complications.
What is the level of evidence provided by this article?
Level III, retrospective cohort study
Please reflect on the guidelines and refer to your practice.
Donors can be reassured as the risk is not higher than general population
Individuals with high uric acid pre-donation are at higher risk especially in African-Americans
Regular monitoring of uric acid post donation as well as careful evaluation of renal function for those with high uric acid post donation is required.
This is a retrospective study to encompass the occurrence of gout in donors. they found that the incidence of gout is higher in African Americans,, men, elderly pateints, compared to Caucasian donors. Additionally, the donors with higher uric acid and gout has increased risk renal failure.
The study limitation are.
Post donation information like BMI, Dietary habits, baseline investigation just like s. creatinine, was not available.
Data collection provided to private insurance, so the non insured donors data not available .
level III.
▪︎Introduction
A decline in renal function causes less uric acid excretion and higher levels of serum uric acid with higher risk of gout in patients with chronic kidney disease (CKD).
serum uric acid increases above pre-donation levels 6 months after donation.
African-Americans have a higher risk of gout compared to Caucasians.
There was an interplay between uric acid and renal function,
decline in renal function post-donation may lead to hyperuricemia and a predisposition to gout
And hyperuricemia also contributes to decline renal disease post-donation.
A recent single center study including 207 women found that 60 μmol/L increase in pre-donation serum uric acid level was associated with a 1.7-times higher risk of >25% decline in eGFR at 6 months post-donation.
this study was done to identify incidence of gout in donors and possible variations according to demographic traits and race
▪︎Methods
retrospective cohort study included living kidney donors who had donated between October 1987 and July 2007 and non donors enrolled in the same insurance benefit during the same time period were sampled as general population controls.
▪︎Results and discussion
-African-Americans donors had twice the likelihood of gout as Caucasians after adjustment for age and sex.
Hyperuricemia in African-Americans may be due to polymorphisms in specific genomic loci.
-Gout was also more common among older and male donors and non donors.
-donors with gout had a higher risk of CKD progression after donation compared to matched donors without gout.
-associations of race with post-donation gout have not been described due to lack of data .
-risk of gout appears to be higher in donors compared to non-donors selected for similar baseline health
supporting that surgical GFR reduction is relevant to uric acid metabolism and associated clinical consequences.
-recent pilot study found that higher pre-donation serum uric acid was associated with larger GFR reductions at 6 months post-donation among women .
– Racial differences in renal risk are multifactorial affected by racial variation and distribution of genetic variants in renal risk allelles such as apolipoprotein-L1.
further study of a possible contribution of gout to the risk of renal dysfunction.
What is the level of evidence provided by this article?
retrospective study, level of evidence III
We Follow up donors for about 6 month and i did not notice rise in uric acid level during this short period
Introduction
· Patients with chronic kidney disease have higher risk of gout due to decreased uric acid excretion and higher levels of serum uric acid
· A recent study found that hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population
· Recent study from Ontario, Canada found that living kidney, were more likely to be diagnosed with gout compared to healthy matched non-donors
· African-Americans had more risk factors for the development of gout including higher serum uric acid levels, more hypertension, and greater use of diuretics
· A recent single center study found that, among female living kidney donors, increase in pre-donation serum uric acid level was associated with higher risk of decline in eGFR at 6 months post-donation
Aim of the study
· To identify post-donation gout and to investigate possible variations within donors according to demographic traits including race
· Comparison of gout between donors and matched general population of non-donors
· Comparison between rates of renal conditions among matched donors with and without gout
Methods
· Data obtained from a data base that integrates the national living donor registry (1987-2007) with billing claims from a private health insurer (2000-2007)
· Frequencies and demographic correlates of gout after donation were studied by Cox regression with left- and right-censoring
· Comparison of rates of renal diagnoses among donors with and without gout was also made , matched 1:3 by age, sex, and race
Results
· study sample of 4,650 donors included 13.1% African-Americans.
· By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors
· Post-donation gout risk also increased with older age at donation and was higher in men
· Gout rates were similar in donors and age- and sex-matched general non-donors
· donors with gout had more frequent renal diseases: AKI, CKD and others
Conclusion
· Donor subgroups at increased risk of gout include African-Americans, older donors, and men.
· Donors have lower gout rates than general-population non-donors early after donation but similar rates during later observation
· Donors with gout have a higher burden of renal complications after demographic adjustment.
Limitations of the study
· data obtained from a private insurance plan, and thus, uninsured living kidney donors are not included
· Pre-donation benefits were captured for only a minority of the donors, and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion
· Some laboratory and habitual data are not available in data sources
· diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals
· race information was not available for non-donors
What is the level of evidence provided by this article?
This is a retrospective case control study, level of evidence III
Please reflect on the guidelines and refer to your practice.
Most of donors missed follow up, but some of them treated for hyperuricemia by most of physicians, even asymptomatic, and many are treated with colchicine as they think it is safer than allopurinol. But I noticed that elevated uric acid in donors may be associated with renal impairment
Introduction
Patients with chronic kidney disease are at high risk of gout and hyperuricemia due to impaired renal excretion of uric acid.
Method
This large observational cohort study addresses the epidemiology of hyperuricemia and the gout effect among the OPTN data registry of living kidney donors in the US from the pharmacy filling and diagnosis code from insurance bills. They collected the data from the private health insurer electronic databases including living kidney donors from the period of October 1987 and July 2007. All donors were enrolled in the insurance benefit plan at some point after a donation from May 2000 to December 2007. while the nondonor group was registered in the same insurance benefits plan during the same time period (may2000-December 2007) and considered as a general population control group. all applicants in this study were joined in medical and pharmacy benefits with an insurer during the study time. Patients’ demographics provided by the transplant center for living kidney donors included age, gender, and race while for the non-donor group race was not included.
Aim of the study
To compare the problem of gout among the donors to a non-donor sample including renal outcome after adjustment to age sex and race
Results
1. In this large cohort study from the OPTN living kidney donors of 4,650 LKD similar to all US registered donors at the same period, the majority were white race 76.3% while only 13.1 % were African American (AA), 8% were Hispanic and only 2.4 other races. The mean age of 37.2 and 45% of LD were men, and 81% were Related living donors, the median follow-up period from donor nephrectomy to the start and close of the observed insurance suitability were of 4.9 and 7.7 years respectively.
2. Cumulative incidence of gout by (diagnostic code or pharmacy fill bills) in donors was 2.5%, over 7 years post donations after adjustment to age and sex only
3. While an adjustment to race this incidence increased to 4.4% in AA, two times higher compared to the white population.
4. There is a linear correlation between the increased rate of gout with increasing donor age
5. Also, gout was found to be three times higher in male donors compared to women.
6. Age is also one of the significant risk factors with increases the risk of gout diagnosis by 6% with each increase in the year of donor age.
7. Gout rates were more among donors taken post-nephrectomy and the prevalence increased over long follow up
Correlations of Gout and Renal Conditions after Living Donation
Among 103 donors with gout found to have more renal diagnosis post donations compared to those without gout diagnosis after matching to age, sex, and race with more AKI diagnosis. compared to CKD, however, donors with gout have similar renal outcomes compared to the nondonors control group with gout
Conclusion
The risk of gout was higher among African-Americans, older donors, and men. Donors with gout have a higher burden of renal problems after demographic modification.
Limitations
Demographic data is limited to age sex, and race, not including other metabolic risk factors like BMI, and serum uric acid, drug history for living donors while insurance records from which most of the data was collected do not include race only age and sex, so race information is not reported for the non-donor group (selection bias).
Also, the uric acid level is not included in the diagnosis based on the insurance claim with diagnostic code and pharmacological prescription which is limited to two drugs only
The observation period for the insurance benefit plan inclusion is wide-ranging between donors (observational bias)
Also, data collection from the pharmacy prescription was limited to two drugs (colchicine and allopurinol) which could be masked with other indications this is an additional selection bias.
missing data for noninsured donors and nondonors
Short follow-up period to address such hard outcomes like CKD
What is the level of evidence provided by this article?
level3 retrospective observational cohort study
Please reflect on the guidelines and refer to your practice.
Monitoring for metabolic changes including hyperuricemia before and after transplantation is part of the transplant workup including BMI, lipid profile HB AIC dietary habit, medications list ,microalbuminuria
1. Please summarise this article in your own words
Introduction:
Hyperuricemia has been associated with decline in kidney function. Recent studies have linked gout with development of CKD in general population.
To understand clinical correlates of gout among a national sample of living kidney donors in the United States (U.S.), we examined a unique database that integrates national registry identifiers of living donors with billing claims from a private health insurer.
Methods
Data sources
This is a retrospective cohort study using linked healthcare databases in the U.S. to ascertain patient characteristics, covariate information, and outcome events. The Organ Procurement and Transplantation Network (OPTN) contains information on all donors, waitlisted patients, and transplant recipients in the U.S.
It included all living donors who donated between 1987 till 2007 and have insurance with the company between 2000-2007. Those donors were compared 1 to 3 with doors without gout.
Correlations of Gout and Renal Conditions after Living Donation
Gout was defined by diagnostic code for gout or pharmacy refill of its typical medications.
Results:
4650 donors like US donors, 76% were Caucasians, 13% African American, 8% were Hispanic. More than 80% of donors were biologically related to recipients. Median duration of follow up after nephrectomy was 4.9 to 7.9 from start to end of observation period.
Incidence of gout was 2.5% after 7years, while for African American the incidence was 4.4% compared to non-donors 2.2 with P value of 0.04.
Donors diagnosed with gout had more renal diagnoses compared to those without gout.
Discussion
Gout in donors was found more common in African American, male and old people similar to general population.
Limitations of the study:
1. Relying on administrative data from insurance company.
2. Donors without insurance not included
3. Pre donation data about gout was not available.
4. Lack of base line clinical data like BMI and gout history.
2. What is the level of evidence provided by this article?
Level 3 case control study
3. Please reflect on the guidelines and refer to your practice.
I do not think this article will change our practise because we are observing donors for gout and check uric acid level periodically.
Chronic kidney disease itself is a risk factor for gout due to reduced renal excretion and at the same time hyperuricemia can lead to progression of CKD.. A recent systematic review and meta-analysis found that hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population
Following donor nephrectomy, living kidney donors lose approximately 30% of their renal function Multiple studies have shown that serum uric acid levels commonly rise above pre-donation levels as early as 6 months after donor nephrectomy.
The demographic and clinical correlates of gout after living kidney donation are
not well described.
In this paper the authors used a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), they identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies.
The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. They also compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race.
The study sample of 4,650 donors included 13.1% African-Americans. By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors.
Post-donation gout risk also increased with older age at donation.
Gout rates were similar in donors and age- and sex-matched general non-donors.
Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure chronic kidney disease and other disorders of the kidney
Conclusion—Donor subgroups at increased risk of gout include African-Americans
older donors
and men.
Donors with gout have a higher burden of renal complications after demographic adjustment.
Limitations
They relied on administrative data from a private insurance plan, and thus, uninsured living kidney donors were not captured.
Predonation diagnoses, such as gout, was not adequate for inclusion.
baseline information on clinical parameters such as body mass index sufficient for inclusion (available for only 5.3% of sample) was lacking.
Laboratory values, such as serum uric acid levels and post- donation serum creatinine, and information on dietary habits, alcohol intake, and over-the- counter medication use were not available.
Diagnosis of gout was based on information provided in billing claims rather than joint fluid aspiration of MSU crystals which could lead to misclassification.
They did not account for the number of physician visits in follow-up.
Lastly, race information was not available for non-donors.
1. Please summarise this article in your own words
2. What is the level of evidence provided by this article?
3. Please reflect on the guidelines and refer to your practice.
Kidney disease is, unfortunately, increasing yearly and the donation pool is needed to be increased. Once this has been done effectively then there will be a less renal failure. Unfortunately, this is not the case. This article deals with gout after living kidney donation and how it correlates with demographic traits and renal complications. It was observed that after a living donor has donated a kidney there was about 30% of kidney function loss. There have been previous studies that demonstrated the rise in uric acid in living donors post-nephrectomy. The population that was markedly affected was African-American when compared to the Caucasian group. Due to kidney donation, there has been a decline in renal function and as such, there is an increase in uric acid that leads to the formation of gout which with its build-up can damage the kidneys and as a result kidney disease.
The study and data collection were obtained from the national living donor registry. The frequency and demographics related to the diagnosis of gout after the donation was estimated using Cox Regression. The size of the population was 4650 after being identified based on the medical diagnosis codes or from filled prescriptions.
The study was a retrospective cohort study using a database that integrates the national registry from the US.
The study found that African –American has twice the possibility of having post-donation gout when related to Caucasians. Gout was also found common in older patients and in male donors.
It was also noted that post-donation gout was higher in males than females. Gout diagnosis and its treatment were not differing from donors when compared to matched non-donors.
During the study, it was noted that there were some limitations like there was no pre-donation diagnosis and as such unaware if there was a diagnosis of gout before. There was no evidence in terms of blood results to know kidney function. There was no information about the donors as it relates to diet.
Therefore, from the study, one can conclude that there is an increase in the formation of gout in living donors mainly African –American when compared to Caucasians, older donors, and the male sex. Also, these donors have a higher risk of kidney disease.
Based on the article, the level of evidence is level 3
In my practice, although limited due to the reason of the non-active transplant program, I believe that it is important to gain knowledge and to apply one day once it is available to ensure proper follow-ups.
This is a retrospective cohort study using US data between October 1987 and July 2007 using a comparison group with data from a health insurance company with data between May 2000 and December 2007. Its objective is to evaluate gout in patients who have donated a kidney.
One way to search for health insurance for patients with gout was the consumption of allopurinol or colchicine in the system but without data on diagnosis and follow-up. There were data such as age and sex, but no data on ethnicity, limiting some comparative findings.
4650 kidney donors were selected, where 76.3% were Caucasian, 13.1% African American, 8.2% Hispanic, and 2.4% fit other races. Adjusting for age and sex, African Americans are at increased risk compared to Caucasians (aHR 1.8, 4.4% vs. 2.4%). In men, it was three times more frequent than in women (aHR 2.8). The risk also increases directly proportional to the age of the donor. The occurrence of gout appears to be higher after nephrectomy HR 1.15.
Gout is related to changes in renal function with no statistical difference between donors and non-donors. Decreased kidney function raises uric acid levels, and African Americans appear more sensitive to hyperuricemia, hypertension, diuretic use, and chronic kidney disease.
The control group was restricted to those with health insurance, thus not being able to assess the population without coverage. We had no data on lifestyle, diet, alcohol consumption, and additional medications, and the diagnosis was restricted to the registration or use of medications, with no additional diagnostic findings.
Abstract:
While a decline in renal function post-donation may lead to hyperuricemia and a
predisposition to gout, given the interplay between uric acid and renal function, it may be
that hyperuricemia also contributes to renal disease post-donation.
Aim was to identify post-donation gout and to investigate possible variations within
donors according to demographic traits including race. We also compared gout among
living kidney donors to that in age- and sex-matched.
Methods Data sources:
A retrospective cohort study using linked healthcare databases in the U.S. to ascertain
patient characteristics, covariate information, and outcome events.
Population studied:
Living kidney donors who had donated between October 1987 and July 2007 and were
enrolled in the insurance benefit plan at some point after donation during May 2000 to
December 2007 (the period of available claims data).
population controls:
Persons who had not donated a kidney (non-donors) and were enrolled in the same
insurance benefit plan at some point during the same time (May 2000 to December
2007) were sampled as general population controls.
Outcomes and covariates:
Diagnostic for gout or pharmacy claim for a medication typically used to treat gout.
Correlations of gout with renal disorders after donation, renal condition diagnoses.
Results:
By seven years post-donation, the cumulative incidence of a diagnostic claim for gout or
a pharmacy fill for a gout medication in the donor sample was 2.5% (95% CI
1.6%-2.4%).
With age and sex adjustment, the seven-year incidence of gout was nearly twice as
common among African-American compared to Caucasian donors (4.4% vs. 2.4%; aHR
1.8; 95% CI 1.0-3.2; P=0.04
There was no significant difference in the primary outcome between Hispanic donors and
Caucasian donors (aHR 0.60; 95% CI 0.19-1.9)
. The risk of a diagnosis of gout or a pharmacy fill for a gout medication rose by 5% with
each increase in year of donor age (aHR 1.05; 95% CI 1.03-1.07)
Correlations of Gout and Renal Condition:
After Living Donation Donors with gout had more frequent post-donation renal diagnoses
compared to a sample of donors without gout, matched 1:3 by age, sex and race. These
patterns reached statistical significance for acute kidney failure.
Discussion:
within the living donor sample, African-Americans had nearly twice the likelihood of
post-donation gout diagnosis or treatment as Caucasians after adjustment for age and
sex (4.4% versus 2.4% at seven years).
Gout was also more common among older and male donors, consistent with patterns
observed in the general population.
Donors with gout had a higher burden of renal diagnoses after donation compared to
matched donors without gout.
Limitation:
Control the entire donor population.
Pre-donation diagnoses, such as gout, was not adequate for inclusion.
Our outcome definition of a diagnosis of gout was based on provider-reported billing
claim not fluid uric acid. In the joint
Lacked baseline information, Laboratory values, such as serum uric acid levels and post
donation serum creatinine, and information on dietary habits, alcohol intake, and over-
the counter medication use were not available.
Conclusion:
Donor subgroups at increased risk of gout include African Americans, older donors, and
men.
Donors have lower gout rates than general-population non-donors early after donation
but similar rates during later observation, suggesting that an initial protective effect of
medical evaluation and selection on gout risk dissipates with time after donation.
Donors with gout also appear to have a higher burden of post-donation renal
complications after demographic adjustment.
Level of evidence 111.
We will consider following up of uric acid in our post transplant donors.
The study outcome definition of a diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals, and may be subject to misclassification.
there is lack of danata,and clinical data
this study has a lot of limitation
Gout after living kidney donation: Correlations with demographic traits and renal complications
Am J Nephrol. 2015
Summary:
This is a retrospective cohort study (level of evidence III) evaluating 4,650 donors (609 are African-Americans) regarding gout risk (evaluated either by medical diagnosis codes or prescription pills for gout) after 7 years of follow-up and comparing them to matched non-donor general population control group.
· Methods:
Design: a retrospective cohort study.
Population: living kidney donors (healthcare databases in the U.S (OPTN) who had donated between October 1987 and July 2007.
control group: non-donors are the general population from the same time period (May 2000 to December 2007).
primary outcome: the first diagnostic billing claim for gout or a pharmacy claim for a medication typically used to treat gout.
· Results:
1. Previous studies reported a higher incidence of gout in donors compared to non-donors, and higher uric acid level 6 months after donation compared to pre-donation level and that may be explained by the surgical reduction of GFR after donation but this study showed no increase in the incidence of gout in donor group when compared to non-donor
2. African-Americans, older age at the time of donation, and male sex are more liable to develop gouty post-donation and then more liable to develop more renal complications including ESRD.
·Conclusion
1. African-Americans, men, and older donors are associated with a higher risk of gout post-donation
2. Gout after the donation is associated with higher adverse renal outcome
· Please reflect on the guidelines and refer to your practice
· KDIGO Guidelines 2017:
1. Donor candidates should be asked about the history of prior episodes of gout.
2. Donor candidates may be informed that donation is associated with an increase in serum uric acid concentration, which may increase the risk for gout.
3. Donor candidates and donors with prior episodes of gout should be informed of recommended methods to reduce their risk of future episodes of gout.
· My practice:
1. evaluation of donors with a history of gouty before donation includes full history regarding a number of stones, recurrent UTI and CT stone study and if the patient was not controlled on medications, history of recurrent stones bilateral, recurrent UTI, or giving the history of heavy NSAIDs intake for pain management, he will be excluded.
2. patient counseling before donations about the risk of developing gouty after donation.
3. following up uric acid after donation in a kidney donor clinic and we consider patients with hyperuricemia (high serum level without manifestations) or gouty (high serum level with manifestations including stones or arthritis) are at more risk of developing ESRD as there is association relationship, not causality relationship.
·Limitations:
1. gouty diagnosis criteria are not clear
2. pre-donation history of gouty, laboratory, and clinical parameters are not clear
3. non-donors control group is from the general population.
examined a linkage of OPTN registry data for LKD with medical and pharmacy claims from a U.S. private health insurer to assess
Baseline characteristics
4650
76.3% caucasian
13.1% AA
8.2% Hispanic
2.1% other
Follow up between kidney donation and observed insurance eligibility 4.9- 7.7 years
Demographic correlation of gout after LK Donation
the cumulative incidence of a diagnostic gout 2.5%
Twice as common among AA compared to compared to caucasian donors
No difference in primary outcome between Hispanic and caucasian donors
The risk increased by 5% per donor year old
Post donation gout was three times higher among male
Complication of gout in living donors and general non donors
Rate of gout diagnosis didn’t differ
Complication of gout and renal conditions after living donation
Donors with gout (103) had more frequent past donation renal diagnoses compared to a donorz without gout
There is statistical significance for acute kidney failure and CKD
Limitations
conclusion
donor subgroups at increased risk of gout include AfricanAmericans, older donors, and men
Donors with gout also appear to have a higher burden of post-donation renal complications after demographic adjustment.
future studies should examine whether the direct impacts of donation on the risk and consequences of gout differ according to demographic traits.
Level III
KDIGO GUIDELINE
Donor candidates should be asked about prior episodes of gout.
Donor candidates may be informed that donation is associated with an increase in serum uric acid concentration, which may increase the risk for gout.
Donor candidates and donors with prior episodes of gout should be informed of recommended methods to reduce their risk of future episodes of gout.
This is the same for our center practice
Following donor nephrectomy, living kidney donors lose approximately 30% of their renal function
Three previous studies have shown that serum uric acid levels commonly rise above pre-donation levels as early as 6 months after donor nephrectomy
In the general population, African-Americans have a higher risk of gout compared to Caucasians
While a decline in renal function post-donation may lead to hyperuricemia and a predisposition to gout, given the interplay between uric acid and renal function, it may be that hyperuricemia also contributes to renal disease post-donation. A recent single center
study including 207 women found that, among female living kidney donors, a 60 μmol/L increase in pre-donation serum uric acid level was associated with a 1.7-times higher risk of >25% decline in estimated glomerular filtration rate (GFR) at 6 months post-donation
Methods Data sources
a retrospective cohort study using linked healthcare databases in the U.S. to ascertain patient characteristics, covariate information, and outcome events. The Organ Procurement and Transplantation Network (OPTN) contains information on all donors, waitlisted patients, and transplant recipients in the U.S..
Analyses were performed using Health Information Portability and Accountability Act-compliant limited datasets, with all direct identifiers removed. These databases have been used for epidemiologic and health services research including study of living kidney donor outcomes
Because of the large sample size, the anonymity of the patients studied, and the non-intrusive nature of the research, a waiver of informed consent was granted per the Department of Health and Human Services Code of Federal Regulations
Population
included living kidney donors who had donated between October 1987 and July 2007 and were enrolled in the insurance benefit plan at some point after donation during May 2000 to December 2007 (the period of available claims data). Persons who had not donated a kidney (non-donors) and were enrolled in the same insurance benefit plan at some point during the same time period (May 2000 to December 2007) were sampled as general population controls. All study participants were simultaneously enrolled in medical and pharmacy benefits with the insurer exclusively during the study period.
Results and Discussion
African-Americans had nearly twice the likelihood of post-donation gout diagnosis or treatment as Caucasians after adjustment for age and sex (4.4% versus 2.4% at seven years).
Gout was also more common among older and male donors, consistent with patterns observed in the general population and in a recent Canadian study of living kidney donors
Second, we found a reduced rate of gout among living donors compared to general non-donors that was limited to donors with earlier study capture in relation to donation
risk of gout dissipates with time after donation.
Third, donors with gout had a higher burden of renal diagnoses after donation compared to matched donors without gout.
reduced rate of gout among living donors compared to general non-donors that was limited to donors captured earlier in the study data in relation to donation, suggesting that a protective effect of medical screening and selection on risk of gout dissipates with time after donation. When living kidney donors were compared to non-donors selected for similar baseline health in Ontario, their risk of gout appears to be higher supporting that surgical GFR reduction is relevant to uric acid metabolism and associated clinical consequences.
When donors with gout were compared to donors without gout, there were significant increases in the rates of post-donation renal conditions, such as acute kidney injury, CKD, and other disorders of the kidney.
limitations
uninsured living kidney donors are not captured and the data reassured by the similarities in baseline characteristics between our cohort and the entire donor population captured in the OPTN
Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
lacked baseline information on clinical parameters such as body mass index sufficient for inclusion (available for only 5.3% of sample), and the OPTN does not collect information on gout baseline gout history. Laboratory values, such as serum uric acid levels and postdonation serum creatinine, and information on dietary habits, alcohol intake, and over-thecounter medication use were not available in our data sources.
We did not account for the number of physician visits in follow-up although in the Canadian study, adjustments for physician visits did not appreciably change the outcome
Lastly, race information was not available for non-donors; however, since 13% of the donors in our study were AfricanAmerican (similar to the proportion of African-Americans in the general U.S. population), African-American representation is unlikely to have produced substantial over-estimates of gout in the non-donors.
Conclusion
The donor subgroups at increased risk of gout include AfricanAmericans, older donors, and men. Donors have lower gout rates than general-population non-donors early after donation but similar rates during later observation, suggesting that an initial protective effect of medical evaluation and selection on gout risk dissipates with time after donation.
Donors with gout also appear to have a higher burden of post-donation renal complications after demographic adjustment.
Better understanding of health outcomes and pharmaceutical care needs in this patient population improves the donor consent process, and guides recommendations for monitoring and management.
Demonstration of comorbidities and related treatment requirements among insured donors supports the importance of long-term follow-up and healthcare access for all living donors.
Leve II
Please summarise this article in your own words
In chronic kidney disease uric acid excretion is decreased thus increasing serum levels leading to Gout. Elevated uric acid levels are associated with progression of CKD. A recent study found hyperuricemia as independent predictor of newly diagnosed CKD in Non CKD population.
Methodology
Data base was used to retrieve data from national living donor registry.
The frequency and demographics co relates of gout after donation was estimated with Cox Regression.
Rates of renal diagnosis among donors with or without matched 1:3 bay sex, race and age.
Results
Total donors- 4650
Afro Americans 13.1% = after 7 years they were twice as likely to develop Gout than White donors
Gout risk increased if age at donation was older
Gout rates were similar in donors and age- and sex-matched general non-donors
High risk of renal failue in donors with Gout than those without Gout.
Conclusion
Africo Americans, males and old donors are more prone to Gout
Those who develop gout are more prone ro renal issues
What is the level of evidence provided by this article?
Observational study
Level 111
Please reflect on the guidelines and refer to your practice.
I will reassure donors that as such donation will not increase the risk of Gout, However a careful watch is required . If such donor develop gout then I will strict surveillance for renal disease
Please summarise this article in your own words
A decline in renal function results in less uric acid excretion and higher levels of serum uric acid contributing to a higher risk of gout in patients with chronic kidney disease (CKD) . A recent systematic review and meta-analysis found that hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population .
-Following donor nephrectomy, living kidney donors lose approximately 30% of their renal function .
-In the general population, African-Americans have a higher risk of gout compared to Caucasians .
-African-Americans had more risk factors for the development of gout including higher serum uric acid levels, more hypertension, and greater use of diuretics.
-It is a retrospective cohort study using linked healthcare databases in the U.S. to ascertain patient characteristics, covariate information, and outcome events.
– They included living kidney donors who had donated between October 1987 and July 2007 and were enrolled in the insurance benefit plan at some point after donation during May 2000 to December 2007 (the period of available claims data).
-The study showed, within the living donor sample, African-Americans had nearly twice the likelihood of post-donation gout diagnosis or treatment as Caucasians after adjustment for age and sex . Gout was also more common among older and male donors.
-Donors with gout had a higher burden of renal diagnoses after donation compared to matched donors without gout.
– Hyperuricemia in African-Americans may be due to polymorphisms in specific genomic loci .
– In the study, they found a reduced rate of gout among living donors compared to general non-donors that was limited to donors captured earlier in the study data in relation to donation, suggesting that a protective effect of medical screening and selection on risk of gout dissipates with time after donation.
– There are limitations of the study :they relied on administrative data from a private insurance plan, and thus, uninsured living kidney donors are not captured.They were reassured by the similarities in baseline characteristics between our cohort and the entire donor population captured in the OPTN (16). Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion. It lacked baseline information on clinical parameters such as body mass index sufficient for inclusion (available for only 5.3% of sample), and the OPTN does not collect information on gout baseline gout history. Laboratory values, such as serum uric acid levels and post-donation serum creatinine, and information on dietary habits, alcohol intake, and over-the-counter medication use were not available in the data sources.
– What is the level of evidence provided by this article?
Level III
Please reflect on the guidelines and refer to your practice.
– In our center, serum uric acid should be done in every follow-up of donors to detect any elevation of it, but we need to encourage long-term follow-up of donors.
Gout after living kidney donation: Correlations with demographic traits and renal complications.
Introduction.
High serum uric acid / Gout associated with decreased renal function mainly due to low uric acid excretion and so incidence is high post kidney donation which might be associated with clinically manifested Gout and decreases GFR.
Aim of the study.
To clarify and well describe demographic and clinical correlates of gout after living kidney donation.
Methods.
A retrospective cohort study, using a database that integrates national registry identifiers of U.S.
Population.
living kidney donors (1987-2007) about 4,650 during (2000-2007), they identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies. they also compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race.
Results.
Baseline Characteristics of the Living Donor Sample.
Regarding race: 76.3% were Caucasian, 13.1% were African-American, 8.2% were Hispanic, and 2.4% were other races.
Gender: 45% were men, mean age at the time of donation was 37.2 years, (81.2%) were biologically related to their recipient with median follow up were 4.9 and 7.7 years.
Demographic Correlates of Gout after Living Kidney Donation.
-The seven-year incidence of gout was nearly twice as common among African-American compared to Caucasian donors.
-Post-donation gout was almost three times higher among male compared to female donors.
-Incidence is increasing with increase in donor age.
-Comparing to matched non-donor group, gout and its renal complications is more common in donors group.
Limitation of the study.
-Selection bias as non-insured donors not concluded.
-Information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
-lacked baseline information on clinical parameters such as body mass index sufficient for inclusion.
-Lack of laboratory values, such as serum uric acid levels and post-donation serum creatinine.
-Lack of information on dietary habits, alcohol intake, and over-the counter medication.
-The number of physician visits in follow-up was not accounted.
-Race information was not available for non-donors.
In conclusion.
Donors is associated high risk of hyperuricemia and donor subgroups at increased risk of gout include African Americans, older donors, and men.
Donors with gout also appear to have a higher burden of post-donation renal complications comparing to matched non-donors groups.
Level of evidence: III
A retrospective cohort study.
Reflect on the guidelines and refer to your practice.
Strict and long term follow up of serum uric acid in post kidney donors and advice for life style modification , diet control and anti-uricosuric medications .
Thank you
The objective:
*To identify post-donation gout and to investigate possible variations within donors according to demographic traits including race.
*To compared gout among living kidney donors to that in age- and sex-matched, general-population non-donors as one benchmark for framing the frequency of post-donation gout.
*To see the possible associations between gout and kidney disease, we compared rates of renal conditions among matched donors with and without gout.
Introduction;
Uric acid level increases with decline in renal function, which may associated with risk of gout in CKD, and this is implicated as a risk factor of development and progression of CKD.
As uric acid post donation rise as early as first 6 month, which attributed to loss of 30% of renal function post donation due to decrease nephron mass, and this is present as following according to the three previuos studies;
higher diagnosis with gout in PK donation, compared to non donor healthy matched group, (3.4% vs 2.0%).
PK donors are more likely to receive proscription treatment against gout, (3.8% vs 1.3%), over 8 years follow up.
A recent single center study including 207 women found that; female living donors a 60 micromole raised of pre donation uric acid associated with a 1.7 times higher risk of >25% reduce in eGFR at 6 month post donation.
Methods:
Data source is from a retrospective cohort study (hence level II evidence), from health care data base in the US, and OPTN which contain all donors informations.
Population;
Donors between October 1987 and July 2007, and the population from same period and not donated considered as controls with the same matched criteria.
Statistical analysis:
Donor were matched as 1:1 with the general non donor group by (age, sex).
Living donors with gout were matched to 1:3 to donors without gout by age , sex, and race.
The study results and outcome
1. The risk of a diagnosis of gout rose by 5% with each increase in year of donor age. Gout was also more common among older and male donors, consistent with patterns observed in the general population.
2. There was no significant difference in the primary outcome between Hispanic donors and Caucasian donors.
3. Post-donation gout was almost three times higher among male compared to female donors.
4. The rates of gout diagnoses and treatments also did not differ among donors compared with matched non-donors.
5. Gout rates were higher among donors captured later after nephrectomy, while lower rates were observed among donors captured earlier, after donation.
6. Renal diagnosis rates among living kidney donors with gout did not differ significantly from that of non-donors with gout.
7. African-Americans had nearly twice the likelihood of post-donation gout diagnosis or treatment as Caucasians after adjustment for age and sex. The higher risk of gout among African- Americans may be attributable to the higher prevalence of risk factors for gout, such as hyperuricemia, hypertension, diuretic use and CKD.
Study’s limitations
a) The study relied on administrative data from a private insurance plan(uninsured living kidney donors are not captured).
b) Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
c) The study lacked baseline information on clinical parameters such as body mass index sufficient for inclusion.
d) Laboratory values, such as serum uric acid levels and post- donation serum creatinine, and information on dietary habits, alcohol intake, and over-the- counter medication use were not available in the study’s data sources.
e) Race information was not available for non-donors
Conclusion
Among the living donor sample, gout was more common African Americans compared to Caucasians
Gout was also more common among older donors and male donors
Compared to the general population, the rate of gout was lower among donors with earlier study capture in relation to donation
Donors with gout had a higher renal diagnosis compared to donors without gout
What is the level of evidence provided by this article?
Level of evidence III- cohort out come study.
Please reflect on the guidelines and refer to your practice.
We use to measure pre-donation uric acid among our living donors, and we use to measure it after donation follow up, but there is less follow up among our donors.
We know that uric acid level reflects nutritional status and is a marker of hypertensive nephropathy and GFR decline, i think this idea of the study should be highlighted to our primary health provider that may have more contact with the donors- to be aware of.
Dear Maksuda
You have copied the reflection from Mohamed (see below) This is unacceptable. This is the last warning. Academic dishonesty is a major offence. We will investigate all your posts. I’m not impressed with this.
Please summarise this article in your own words
Introduction:
Gout affect 8 million Americans leading to significant morbidity, decreased physical function, productivity and quality of life, this incraeses with CKD and patients age in the general population and related to decline in kidney function in the general population.
This study conducted to know the incidence of gout among kidney donors, and what are the risk factors increasing the risk.
Study design:
Retrospective cohort study, included 4650 U.S donors, almost 14% were african american, during 7 years follow up period, collecting data from the insurer diagnosis of gout or medical prescription of anti -gout medications, informed consent was granted per department of health and human services.
Results:
African american were twice more to experience gout than the caucasian.
The risk of a diagnosis of gout or a pharmacy fill for a gout medication rose by 5% with each increase in year of donor age (P= 0.0001).
Post-donation gout was almost three times higher among male compared to female donors (P<0.0001).
Donor age resulting in a 6% increase in risk of a gout diagnosis (P<0.0001), and a 5% increase in risk of receiving a medication for gout (P=0.0006).
The diagnosis of gout increased by time among donors compared to non donors early in the study but it was not of clinical significance.
Donors with gout were more to develop post-donation renal diagnoses compared to a sample of donors without gout, matched 1:3 by age, sex and race. These patterns reached statistical significance for acute kidney failure, CKD, and other disorders of the kidney. But this was not significant when compared with non donors with gout.
Study limitations:
Conclusion:
Donors are at increased risk to develop gout later post donation in comparison to non donors, this was more among older donors, African American, and male gender.
Donors had lower gout rates when compared to general population.
What is the level of evidence provided by this article?
Level of evidence III- cohort out come study.
Please reflect on the guidelines and refer to your practice.
We use to measure pre-donation uric acid among our living donors, and we use to measure it after donation follow up, but there is less follow up among our donors.
We know that uric acid level reflects nutritional status and is a marker of hypertensive nephropathy and GFR decline, i think this idea of the study should be highlighted to our primary health provider that may have more contact with the donors- to be aware of.
Thank you, Mohamed for your reflection. I agree with you
1-Summary of this article
Introduction
Following nephrectomy living kidney donors lose about 30% of their renal function .
Uric acid levels rise above pre-donation levels as early as 6 month after donor nephrectomy (by previous study).
Limitation of this study no available information on race .,75% are Caucasian ,so these result may not be generalized to non-Caucasian donors.
Primary aim in this study to identify post donation gout and to investigate possible variation within donor according to demographics traits including race.
Compare living kidney donors so that in age and sex matched general population nondonors for the frequency of post donation gout .
Methods
Population include living kidney donor who had donated between October 1987 and July 2007 person who had not donated a kidney (non-donor)and were enrolled in the same insurance benefit plan at same point during the same time peroid9may2000 to dec 2007) were sampled as general population controls.
To examine corelation of gout with renal disorder after donation renal condition diagnosis were also extracted based on 9-CM diagnostic code and included AKI,CKD ,Renal failure ,nephrolithiasis and other renal disorder.
Result
7 years post donation the cumulative incidence of a diagnostic claim for gout or pharmacy for gout medication in donor sample was 2.5%.
Seven years incidence of gout among African more than Caucasian.
Male and African donor more gout diagnosis and the use of gout medication.
Gout rate were higher among donors versus non-donor.
Donor with gout had more frequent post donation renal diagnosis to a sample of donors without gout.
Discussion:
Based on information source finding are:
Living donor African -American had almost twice the like hood of post donation gout diagnosis or treatment as Caucasian after adjustment for age and sex.
Gout more common among older and male donors.
Recent studies have identified higher serum uric acid levels in living donors compared to pre donation level.
Hyperuricemia in African -American may be due to polymorphism in specific genomic loci(35-37) so this group of donor has a higher risk of HTN and ckd after donation.
The result suggest donors who develop gout has higher rate of renal condition compared to donor without gout .
Limitation of the study :
Data collect from a private insurance plan ,thus living donors are not captured.
Pre donation diagnosis (gout)was not adequate for inclusion ,due to the nature of OPIN collection of baseline donor data.
Lack of baseline information such as BMI.
Important data absence in data sources such as some lab value serum(uric acid and creatinine),information of the dietary habit ,Alcohol intake and over counter medication.
The current study link national donor registry data with medical billing and pharmacy fill recent to follow outcome.
Unlike Canadian study we were able to assess pharmacy fill calms for cohort and not just for older than 65 years for provisional drug covering.
Conclusion:
Increased risk of gout in African American ,older donor and men.
Donors have lower gout rate than general population non donor early after donation and similar rate later after donation.
Further studies needed to examine whether the direct impacts of donation on risk and consequences of gout differ according to demographic traits.
2- cohort study level 3
follow up of donor in our every 3 month in first year but unfortunately most of the donor lost their follow up so it is difficult to comment on long term follow up gout post donation in our patients.
Thank you
Gout after living kidney donation: Correlations with demographic traits and renal complications
Summary of the article
This is a retrospective cohort study using linked healthcare databases in the U.S, included 4,650 living kidney donors who had donated between October 1987 and July 2007. The primary aim was to identify post-donation gout and to investigate possible variations within donors according to demographic traits including race. The study compared gout among living kidney donors to that in age- and sex-matched, general-population non-donors as one benchmark for framing the frequency of post- donation gout.
The study results and outcome
1. The risk of a diagnosis of gout rose by 5% with each increase in year of donor age. Gout was also more common among older and male donors, consistent with patterns observed in the general population.
2. There was no significant difference in the primary outcome between Hispanic donors and Caucasian donors.
3. Post-donation gout was almost three times higher among male compared to female donors.
4. The rates of gout diagnoses and treatments also did not differ among donors compared with matched non-donors.
5. Gout rates were higher among donors captured later after nephrectomy, while lower rates were observed among donors captured earlier, after donation.
6. Renal diagnosis rates among living kidney donors with gout did not differ significantly from that of non-donors with gout.
7. African-Americans had nearly twice the likelihood of post-donation gout diagnosis or treatment as Caucasians after adjustment for age and sex. The higher risk of gout among African- Americans may be attributable to the higher prevalence of risk factors for gout, such as hyperuricemia, hypertension, diuretic use and CKD.
Study’s limitations
a) The study relied on administrative data from a private insurance plan(uninsured living kidney donors are not captured).
b) Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
c) The study lacked baseline information on clinical parameters such as body mass index sufficient for inclusion.
d) Laboratory values, such as serum uric acid levels and post- donation serum creatinine, and information on dietary habits, alcohol intake, and over-the- counter medication use were not available in the study’s data sources.
e) Race information was not available for non-donors.
Study’s strengths
a) It is the first study to assess racial variation in the risk of gout in living kidney donors.
b) The ability to link national donor registry data with medical billing and pharmacy fill records.
What is the level of evidence provided by this article?
This is a retrospective study cohort
Level of evidence grade 3.
Please reflect on the guidelines and refer to your practice
To the best of my knowledge, there is no published study related to gout incidence and complications among the donors in my country. Routine follow-up of donors cases in the referred clinics, encountered variable levels( exceeding the upper limit of normal) of serum uric acid among donors.
Thank you Safi, because it was not tested. Kidney donation is associated with increased uric acid and possibly gout.
# Please summarise this article in your own word
# The objective:
*To identify post-donation gout and to investigate possible variations within donors according to demographic traits including race.
*To compared gout among living kidney donors to that in age- and sex-matched, general-population non-donors as one benchmark for framing the frequency of post-donation gout.
*To see the possible associations between gout and kidney disease, we compared rates of renal conditions among matched donors with and without gout.
# Introduction
*The deterioration of kidney function leads to reduce uric acid excretion and higher levels of serum uric acid and as a result increase the risk of gout in (CKD) patients.
*Elevated serum uric acid levels have been implicated as a risk factor for the development and progression of CKD.
* A recent systematic review and meta-analysis found that hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population.
*Following donor nephrectomy, living kidney donors lose approximately 30% of their renal function and serum uric acid levels commonly rise above pre-donation levels as early as 6 months after donor nephrectomy.
# Methods:
A retrospective cohort study using a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), we identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies.The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. We also compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race.
# Results:
**Baseline Characteristics of the Living Donor Sample
*The baseline evaluaton for the 4,650 living kidney donors in the study were similar to that of all U.S.
* living kidney donors registered in the OPTN in the same period.
*Among the donors, 76.3% were Caucasian, 13.1% were African-American, 8.2% were Hispanic, and 2.4% were other races.
*The mean age at the time of donation was 37.2 years, and 45% were men.
* Most living kidney donors (81.2%) were biologically related to their recipient.
*The median duration from donor nephrectomy to the start and end of the observed insurance eligibility were 4.9 and 7.7 years, respectively.
**Demographic Correlates of Gout after Living Kidney Donation
*By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors (4.4% vs. 2.4%)
*There was no significant difference in the primary outcome between Hispanic donors and Caucasian donors.
* The risk of a diagnosis of gout or a pharmacy fill for a gout medication rose by 5% with each increase in year of donor age.
* Post-donation gout was almost three times higher among male compared to female donors.
*When the components of the primary outcome were examined separately, age remained a significant risk factor, with each increase in year of donor age resulting in a 6% increase in risk of a gout diagnosis and a 5% increase in risk of receiving a medication for gout .
*Male donors were more than three times as likely as female donors to receive a gout diagnosis and almost five times as likely to receive a medication for gout .
*Comparison of Gout in Living Donors and General Non-Donors
* Gout occurred at a rate of 16.0 per 1000 person-years in living kidney donors compared with a statistically similar rate of 18.6 per 1000 person-years in the age- and sex-matched non-donors.
*The diagnoses and treatments also did not differ among donors compared with matched non-donors
*A diagnosis of gout and/or a pharmacy fill for a prescription for gout was more common among men versus women in both donors and general non-donors.
**Correlations of Gout and Renal Conditions after Living Donation
*Donors with gout had more frequent post-donation renal diagnoses compared to donors without gout.
* Renal diagnosis rates among living kidney donors with gout did not differ significantly from that of non-donors with gout.
# The limitation:
*The accounting data from a private insurance plan, so that uninsured living kidney donors are not taken.
*Pre-donation benefits were gained for a minority of the donors, and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
*lacked baseline information on clinical parameters such as body mass index
* Laboratory estimates, such as serum uric acid levels and post-donation serum creatinine, and information on dietary habits, alcohol intake, and over-the-counter medication use were not available in our data sources.
*Not account for the number of physician visits in followup.
*Race information was not available for non-donors.
# The strength and contributions
*The link national donor registry data with medical billing and pharmacy fill records to follow outcomes not captured in the registry among more than 4000 living kidney donors.
* Assess pharmacy fill claims for the entire cohort and not just for those older than 65 years of age who are eligible for provincial drug coverage.
* Electronic pharmacy fill claims have been shown to be highly accurate records of physician prescribing.
*It is a first study to assess racial variation in the risk of gout in living kidney donors.
#Conclusion:
*Donor subgroups at increased risk of gout include African-Americans, older donors, and men.
* Donors have lower gout rates than general-population non-donors early after donation but similar rates during later observation, suggesting that an initial protective effect of medical evaluation and selection on gout risk dissipates with time after donation.
* Donors with gout also appear to have a higher burden of post-donation renal complications after demographic adjustment.
*Demonstration of comorbidities and related treatment requirements among insured donors supports the importance of long-term follow-up and healthcare access for all living donors.
*Future studies should examine whether the direct impacts of donation on the risk and consequences of gout differ according to demographic traits.
# What is the level of evidence provided by this article?
*Retrospective cohort study level 3
# Please reflect on the guidelines and refer to your practice.
*In practice, we measure UA and other events that have adverse effect on renal function for all donors routinely, but we don’t have sufficient data post transplantation. We hope in the near future to increase the number of studies and to be able to apply them.
Thank you
Introduction
A decline in renal function results in reduced uric acid excretion and subsequent hyperuricemia. Hyperuricemia has been known to cause renal dysfunction and worsen pre-existing renal dysfunction.Kidney donors have a reduction in GFR of up to 30% and hence, are at a high risk of developing hyperuricemia and gout
Methodology
This was a retrospective cohort study using linked healthcare databases in the U.S to ascertain patient characteristics, covariate information and outcome events. Data for donors was obtained from the OPTN registry and linked with names and dates of birth to beneficiary identifiers from national private health insurer electronic databases
All living donors who had donated a kidney between October 1987 and July 2007 and who were enrolled in the insurance benefit planter donation during May 2000 to December 2007 were included in the study. Non-donors who were enrolled in the same insurance plan during the same time period were included as the general population controls
The primary outcome was a composite of first diagnostic billing claim for gout or pharmacy claim for a medication typically used to treat gout.
Components of the primary outcome were also analyzed separately.
To examine possible correlations of gout with renal disorders after donation, renal condition data were also extracted based on ICD-9-CM diagnostic codes and included AKI, CKD, renal failure (unspecified), nephrolithiasis and other renal disorders.
Information on ethnicity was not provided for non-donors.
To compare the burden of gout among donors to a non-donor sample, donors were matched 1:1 with non-donors by age and sex
Living donors with gout were matched in a ratio of 1:3 to donors without gout by age and gender.
Renal conditions diagnosis was compared between donors with and without gout and expressed as ratios.
A total of 4650 living kidney donors were included in the study: 76.3% were Caucasians, 13.1% were African Americans, 8,2% were Hispanics and 2.4% were other races.
The mean age at donation was 37.2 years and 45% of the living kidney donors were males. 81.2% of the living donors were biologically related to their recipients.
Results
The 7 year cumulative incidence of the primary outcome (a composite of a diagnostic claim for gout or a pharmacy fill for a gout medication) in the donor sample was 2.5%.
With age and gender adjustment, the 7 year incidence of gout was nearly twice as common among African Americans compared to Caucasians (4.4% vs 2.4%, aHR 1.8, p value=0.04)
There was no significant difference in the primary outcome between Hispanics and Caucasians.
The risk of gout diagnosis or pharmacy fill for a gout medication rose by 5% with each increase in donor age (aHR 1.05 p< 0.0001)
Post donation gout was almost three times higher among males compared to female donors (aHR 2.80 p<0.0001)
When the components of the primary outcome were analyzed separately, age remained a significant risk factor, with each increase in year of donor age resulting in a 6% increase in risk of gout diagnosis and a 5% increase in risk of receiving a medication for gout
Male donors were more than 3 times as likely as female donors to receive a gout diagnosis and almost 5 times as likely to receive a medication for gout.
In the matched pair comparisons, there was no statistically significant difference among donors and non-donors. The diagnosis of gout was more common in men than women in both donors and non-donors
Donors with gout had more frequent post donation renal diagnosis compared to donors without gout. These patterns reached statistical significance for AKI, CKD and other kidney disorders.
Conclusion
Among the living donor sample, gout was more common African Americans compared to Caucasians
Gout was also more common among older donors and male donors
Compared to the general population, the rate of gout was lower among donors with earlier study capture in relation to donation
Donors with gout had a higher renal diagnosis compared to donors without gout
Limitations
Level of evidence
This is a retrospective cohort and included case controls – level 3 evidence
Practice in home country
We don’t routinely measure uric acid levels post donation due to cost constraints. It is only done pre-donation
We shall need to incorporate uric acid level measurements in the post donation follow up
Thank you, yes, Uric acid is an important test
Gout after living kidney donation: Correlations with
demographic traits and renal complications
♧Introduction
▪︎There is a higher risk of gout in patients with CKD and an elevated serum uric acid levels have been implicated as a risk factor for the development and progression of CKD. ▪︎Following donor nephrectomy, living kidney donors lose approximately 30% of their renal function. ▪︎Three previous studies have shown that serum uric acid levels commonly rise above pre-donation levels as early as 6 months after donor nephrectomy.
While a decline in renal function post-donation may lead to hyperuricemia and a predisposition to gout, given the interplay between uric acid & renal function, it may be that hyperuricemia also contributes to renal disease post-donation.
♧ The aims of this study were:
1. To identify post-donation gout and to investigate possible variations within donors according to demographic traits including race.
2. To compare gout among living kidney donors to that in age- and sex-matched,
general-population non-donors
3.To compare rates of renal conditions among matched donors with and without gout.
♧Methods:
This study have used a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), it identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies. The frequencies & demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. They compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race.
♧ Results:
▪︎The study sample of 4,650 donors included 13.1% African-Americans. ▪︎By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors ▪︎Post-donation gout
risk also increased with older age at donation and was higher in men.
▪︎Gout rates were similar in donors and age- and sex-matched general non-donors.
▪︎Compared to matched donors without gout, donors with gout had more
frequent renal diagnoses, reaching significance for acute kidney failure, chronic kidney disease , and other disorders of the
kidney.
Conclusion:
Post-donation gout risk include African American race, old age, male gender and presence of kidney disease.
♧Level of evidence: III
Thank you
Please summarise this article in your own words :
1- 4650 donors were included, 13.1 % of them were african americans.
2- Gout rates were similar in donors and matched non-donors.
3- By 7 years, the incidence of gout in african american donors was double that in caucasian donors (4.4 versu 2.2 %)
4- older age donors were more likely to develop gout than younger age with a hazard ration of 1.06/year.
5- men donors were more likely to develop gout than women with a hazard ratio of 2.8
6- kidney disease was more prevalent in donors with gout than donors without gout.
What is the level of evidence provided by this article?
Please reflect on the guidelines and refer to your practice.
Thank you
Summary:
Aim of the study:
Methods:
Design: a retrospective cohort study.
Data source: healthcare databases in the U.S (OPTN).
Population: living kidney donors who had donated between October 1987 and July 2007.
Persons who had not donated a kidney (non-donors) during the same time period (May 2000 to December 2007) were sampled as general population controls.
The primary outcome was a composite of the first diagnostic billing claim for gout or a pharmacy claim for a medication typically used to treat gout.
To examine possible correlations of gout with renal disorders after donation, renal condition diagnoses were also extracted based on ICD-9-CM, including acute kidney injury, CKD, renal failure (unspecified), nephrolithiasis, and other renal disorders. Baseline demographic information ascertained for living kidney donors from the OPTN at the time of donation included age, sex, and race, as reported by the transplant center.
Results:
The study sample of 4,650 donors included 13.1% African-Americans.
By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors.
Post-donation gout risk also increased with older age at donation and was higher in men.
Gout rates were similar in donors and age- and sex-matched general non-donors. Compared to matched donors without gout, donors with gout had more frequent renal diagnoses.
Conclusion:
Donor subgroups at increased risk of gout include African-Americans, older donors, and men.
Donors with gout have a higher burden of renal complications after demographic adjustment.
Level 3 (retrospective cohort study).
KDIGO Guidelines 2017:
Thank you
The type of the study ;
a retrospective cohort study.
Ethical approval;
from the Saint Louis University Institutional Review Board and HRSA.
Outcomes o the study ;
The primary outcome was a composite of the first diagnostic billing claim for gout or pharmacy claim for a medication typically used to treat gout.
Population ;
The study sample of 4,650 donors included 13.1% African-Americans.
Method ;
The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. The study also compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race.
Statistical analysis ;
Datasets were merged and analyzed with SAS (Statistical Analysis Software) version 9.3 (SAS Institute Inc., Cary, NC). In all outcome analyses, we interpreted two-tailed P-values <0.05 as statistically significant.
The result ;
1- African-Americans were almost twice as likely to develop gout as Caucasian donors .
2- Post-donation gout risk also increased with older age at donation and was higher in men .
3-Gout rates were similar in donors and age- and sex-matched general non-donors .
4-Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure , chronic kidney disease , and other disorders of the kidney .
The limitations;
1-The study relied on administrative data from a private insurance plan, and thus, uninsured living kidney donors are not captured.
2-Pre-donation benefits were captured for only a minority of the donors (7.7%), and thus, information on pre-donation diagnoses, such as gout, was not adequate for inclusion.
3-The study lacked baseline information on clinical parameters such as body mass index sufficient for inclusion (available for only 5.3% of sample), and the OPTN does not collect information on gout baseline gout history.
4-Laboratory values, such as serum uric acid levels and post- donation serum creatinine, and information on dietary habits, alcohol intake, and over-the-counter medication use were not available in our data sources.
5- The study outcome definition of a diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals, and may be subject to misclassification.
6-race information was not available for non-donors; however, since 13% of the donors in our study were African- American (similar to the proportion of African-Americans in the general U.S. population), African-American representation is unlikely to have produced substantial over-estimates of gout in the non-donors.
Conclusion;
Donor subgroups at increased risk of gout include African-Americans, older donors, and men. Donors with gout have a higher burden of renal complications after demographic adjustment.
2-What is the level of evidence provided by this article?
Level III.
3-Please reflect on the guidelines and refer to your practice.
The study suggest that, an initial protective effect of medical evaluation and selection on gout risk dissipates with time after donation. Donors with gout also appear to have a higher burden of post-donation renal complications after demographic adjustment.
In my practice ;screening for gout is a part of pre transplant evaluation .Post kidney transplant screening of donors or gout is not a routine .
Thank you
Please summarise this article in your own words
Introduction
CKD is associated with higher levels of serum uric acid & consequently higher risk of gout.
Elevated serum uric acid level is a risk factor for CKD & its progression.
In a recent systematic review & meta-analysis, hyperuricemia independently predicted newly diagnosed CKD in non-CKD population.
Serum uric acid levels rise above pre-donation levels as early as 6 months after donor nephrectomy.
Methods
A retrospective cohort study using linked healthcare databases in the U.S.
Aim
To examine possible correlations of gout with renal disorders after donation Population
All LKDs who had donated between Oct 1987 & July 2007
Period of study: May 2000 to Dec 2007.
Non–donors enrolled in the same insurance plan were used as general population controls. All participants were enrolled in medical & pharmacy benefits with the insurer exclusively during the study period.
Primary outcome was the composite of the 1stdiagnostic billing claim for gout or pharmacy claim for a gout medication (allopurinol or colchicine).
Components of the primary outcome were also analyzed separately.
Statistics
Data were analyzed with SAS version 9.3.
Demographic Correlates of Gout after LKD
Cox regression with censoring used to estimate the frequency of outcomes over time & evaluate any associations with donor characteristics, specifically race.
Comparison of Gout in Living Donors & General Non-Donors
Donors were matched 1:1 with general non-donors by age & sex when benefits began. Diagnostic billing claims &/or pharmacy fill rates in donors & matched non-donors were compared as rate ratios.
Correlations of Gout & Renal Conditions after Living Donation
Living donors with gout were matched 1:3 to donors without gout by age, sex, & race. Rates of renal conditions diagnoses in the donors with & without gout were compared as rate ratios.
Results
Baseline Characteristics of the Living Donor Sample
The baseline characteristics for the 4,650 LKDs in the study cohort were similar to that of all U.S. LKDs registered in the OPTN in the same period.
A 76.3% of the donors were Caucasian, 13.1% African-American, 8.2% Hispanic, & 2.4% other races.
Mean age at donation 37.2 years, & 45% were men.
Most LKDs (81.2%) were biologically related to the recipients.
Median duration from nephrectomy to start & end of the observed insurance eligibility were 4.9 & 7.7 years, respectively.
Demographic Correlates of Gout after LKD
The 7-year incidence of gout was twice as common among African-American compared to Caucasian donors (4.4% vs. 2.4%; P=0.04).
No difference in the primary outcome between Hispanic & Caucasian donors.
The risk of gout rose by 5% with each increase in year of donor age.
Post-donation gout was three times higher among male compared to female donors (P<0.0001).
Male donors were >3 times as likely as female donors to receive a gout diagnosis & 5 times as likely to receive a medication for gout.
Trends towards more gout diagnoses & the use of gout medications among African-American compared with Caucasian donors (not statistically significant).
Comparison of Gout in LKDs & General Non-Donors
Gout occurred at a rate of 16.0/1000 person-years in LKDs compared with a similar rate of 18.6 /1000 person-years in matched non-donors.
Rates of gout diagnoses & treatments also did not differ among donors compared with matched non-donors (13.4/1000 person-years vs 15.0/ 1000 person-years).
A diagnosis of gout was more common among men versus women in both donors & general non-donors.
Correlations of Gout & Renal Conditions after Living Donation
Donors with gout (n=103) had more post-donation renal diagnoses compared donors without gout:
ARF (rate ratio 12.5)
CKD (rate ratio 5.0)
Other disorders (rate ratio 2.3).
Renal diagnosis rates among LKDs with gout did not differ significantly from that of non-donors with gout
Discussion
Among the living donors, African-Americans had twice the likelihood of post-donation gout diagnosis or treatment as Caucasians (4.4% versus 2.4% at 7 years).
Gout was more common among older & male donors, similar to that seen in the general population & in a recent Canadian study of LKDs.
There is a reduced rate of gout among LKDs vs general non-donors that was seen only after donation (the initial protective effect of donor medical evaluation & selection on the risk of gout decreased with time after donation).
Donors with gout had a higher burden of renal diagnoses after donation compared to matched donors without gout.
Gout affects >8 million Americans & hav significant morbidity & economics impacts.
The incidence & prevalence of gout is increasing & of particular concern in elderly & in patients with CKD.
A 10-year incidence of gout is 49% for uric acid levels ≥9 mg/dL vs. 1% for levels <7.0 mg/dL).
The higher risk of gout among African-Americans may be due to the higher prevalence of risk factors for gout (HTN, hyperuricemia, diuretic use, & CKD). Hyperuricemia in African-Americans may be genetically determined.
In donors with gout vs those without gout, there were significant increases in the rates of post-donation renal conditions (AKI, CKD, & others).
A recent pilot study reported that higher pre-donation uric acid was associated with larger GFR reductions at 6 months post-donation among women.
Limitations
Reliance on data from a private insurance plan; uninsured LKDs are not included.
Pre-donation benefits were captured for only a minority of the donors (7.7%); thus, data on pre-donation diagnoses, such as gout, was not adequate for inclusion.
Lack of baseline information on clinical parameters such as BMI sufficient for inclusion.
Laboratory values (uric acid levels & post-donation creatinine) were not available.
Definition of gout was based on billing claims, rather than joint fluid aspiration for urate crystals(subject to misclassification). Race information not available for non -donors.
Strengths & contributions
The ability to link national donor registry data with medical billing & pharmacy fill records to follow outcomes not captured in the registry among >4000 LKDs.
Pharmacy fill claims were assessed for the entire cohort & not just for those >65 years of age who are eligible for provincial drug coverage.
This is the 1ststudy to assess racial variation in the risk of gout in LKDs.
Conclusion
Donor subgroups at increased risk of gout are African-Americans, older donors, &men. Donors have lower gout rates than general-population non-donors early post donation but similar rates later; the initial protective effect of evaluation & selection on gout risk dissipates with time after donation.
Donors with gout have a higher burden of post-donation renal complications.
==========================
What is the level of evidence provided by this article?
Level III, retrospective cohort study
==========================
Please reflect on the guidelines and refer to your practice.
In our center, we perform 8 to 10 living kidney donors transplants per month.
Most of the recipients have governmental insurance coverage; however, the recipients’ insurance does not cover that of the donors.
In addition, there is a lack of formal follow up plan for kidney donors in our centers.
Therefore, we have no any available data regarding the magnitude of gout in our living donors. We should consider this in our future plans.
Thank you
Introduction;
Uric acid level increases with decline in renal function, which may associated with risk of gout in CKD, and this is implicated as a risk factor of development and progression of CKD.
As uric acid post donation rise as early as first 6 month, which attributed to loss of 30% of renal function post donation due to decrease nephron mass, and this is present as following according to the three previuos studies;
Methods:
Data source is from a retrospective cohort study (hence level II evidence), from health care data base in the US, and OPTN which contain all donors informations.
Population;
Donors between October 1987 and July 2007, and the population from same period and not donated considered as controls with the same matched criteria.
Statistical analysis:
Results:
Separate end point examination:
Compare gout incidence between donors and general non donors:
gout incidence occur at rate of 16 per 1000 person/year in living KD, compared with 18.6% per 1000/year in the age and sex-matched non-donors.
Discussion:
Level of evidence :Retrospecitve cohort study ((III)).
Reflection to our practice;
Thank you
Hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population. While a decline in renal function post-donation may lead to hyperuricemia and a predisposition to gout, it may be that hyperuricemia also contributes to renal disease post-donation.
Primary aim:
– To identify post-donation gout and to investigate possible variations within donors according to demographic traits including race.
– Compared gout among living kidney donors to that in age- and sex-matched, general-population non-donors as one benchmark for framing the frequency of post-donation gout. matched 1:1
– Compared rates of renal conditions among matched donors with and without gout, they were matched 1:3
Methods
Data sources: Retrospective cohort study using linked healthcare unique database that integrates national registry identifiers of living donors with billing claims from a private health insurer.
Population
– living kidney donors who had donated between October 1987 and July 2007, who were enrolled in the insurance benefit plan at some point after donation during May 2000 to December 2007.
– Non-donors and were enrolled in the same insurance benefit plan at some point during the same time period were sampled as general population controls.
Results
– The study sample of 4,650 donors included 76.3% were Caucasian and 13.1% African-Americans.
– By seven years, the cumulative incidence of gout the donor sample was 2.5%.
– African-Americans were almost twice as likely to develop gout as Caucasian donors (4.4% vs. 2.4%; aHR, 1.8)
– Post-donation gout risk also increased with older age at donation (aHR per year 1.05) and was higher in men (aHR 2.80).
– Gout rates were similar in donors and age- and sex-matched general non-donors.
– Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for AKI (rate ratio 12.5), CKD (rate ratio 5.0), and other disorders of the kidney (rate ratio 2.2).
Conclusion: Donor subgroups at increased risk of gout include African-Americans, older donors, and men. Donors with gout have a higher burden of renal complications after demographic adjustment.
Limitations:
– Outcome definition of a diagnosis of gout was based on provider-reported billing claims, rather than true diagnostic test.
– Uninsured living kidney donors are not captured as the data relied on administrative data from a private insurance plan.
– Information on pre-donation diagnoses, such as gout, was not adequate for inclusion, as pre-donation benefits were captured for only a minority of the donors.
– Laboratory values, such as serum uric acid levels and post-donation serum creatinine, and information on dietary habits, alcohol intake, and over-the-counter medication use and BMI were not available.
– Race information was not available for non-donors.
– What is the level of evidence provided by this article?
Retrospective cohort study level 3.
– Please reflect on the guidelines and refer to your practice.
I thick donor can be reassured as the risk is not higher than general population. However, those with high uric acid pre-donation their risk may be higher along with some racial subgroup.
Regular monitoring of uric acid post donation. Careful evaluation of renal function for those with high uric acid post donation.
Thank you
– A decline in renal function results in less uric acid excretion and higher levels of serum uric acid contributing to a higher risk of gout in patients with chronic kidney disease
– elevated serum uric acid levels have been implicated as a risk factor for the development and progression of CKD . A recent systematic review and meta-analysis found that hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population.
– Following donor nephrectomy, living kidney donors lose approximately 30% of their renal function . Three previous studies have shown that serum uric acid levels commonly rise above pre-donation levels as early as 6 months after donor nephrectomy
– In the general population, African-Americans have a higher risk of gout compared to Caucasians
– Aim of this study was to identify post-donation gout and to investigate possible variations within donors according to demographic traits including race. also compared gout among living kidney donors to that in age- and sex-matched, general-population non-donors as one benchmark for framing the frequency of post donation gout.
Methods :
– Using a unique database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007), study identified post-donation gout based on medical diagnosis codes or pharmacy fills for gout therapies. The frequencies and demographic correlates of gout after donation were estimated by Cox regression with left- and right-censoring. also compared rates of renal diagnoses among donors with and without gout, matched 1:3 by age, sex, and race.
Results:
– The study sample of 4,650 donors included 13.1% African-Americans. By seven years, African-Americans were almost twice as likely to develop gout as Caucasian donors .
– Post-donation gout risk also increased with older age at donation and was higher in men . Gout rates were similar in donors and age- and sex-matched general non-donors . Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for acute kidney failure , chronic kidney disease , and other disorders of the kidney .
Discussion :
– within the living donor sample, African-Americans had nearly twice the likelihood of post-donation gout diagnosis or treatment as Caucasians after adjustment for age and sex.
– Gout was also more common among older and male donors, consistent with patterns observed in the general population and in a recent Canadian study of living kidney donors .
– reduced rate of gout among living donors compared to general non-donors that was limited to donors with earlier study capture in relation to donation, suggesting that an initial protective effect of donor medical evaluation and selection on the risk of gout dissipates with time after donation.
– donors with gout had a higher burden of renal diagnoses after donation compared to matched donors without gout.
Conclusion:
– high adverse renal outcomes associated with increased uric acid after kidney donation .
– risk increase with African-Americans , men & older donors .
level of evidence :
level 3 (retrospective observational study )
on my practice , screening of uric acid level & treating hyperuricemia is usually part of our routine work up
Thank you, retrospective cohort study.
SUMMARY
Introduction
The main organ of excretion of uric acid is kidney and it has been shown that there is a reduction in filtration capacity of the remaining kidney after nephrectomy due to loss of about 30% of it function, hence resulting in accumulation of uric acid level in the blood and development of gout. Similarly, high level serum uric acid has been associated with development and progression of CKD among kidneys donors.
Aim
Method
Result
Conclusion
This is a level 3 retrospective cohort study
Reflecting on this guideline in relation to my practice where i work requires us to promote long term follow up of donors and pay a closer attention to donors with elevated uric acid level during the work up stage. Also to advice lifestyle changes with good dietary advice on the food with high purine level.
Thank you
Kidney donors have approximately 30% decline in kidney function post donation, renal impairment is associated with hyperuricemia and predispose to gout, also hyperuricemia may contribute to renal disease post donation.
Gout can lead to significant morbidity and impairs quality of life, decrease in kidney function can lead to elevated serum uric acid and increased risk of gout.
This study aims to evaluate the demographic and clinical correlates of gout among sample of living kidney donors in US and to identify post donation gout and possible variation in donors according to demographic traits and aimed to determine frequency of post donation gout through comparing gout in living donors and matched non donors.
It is a retrospective cohort study including 4650 living kidney donors and nondonors sampled as general population controls.
The primary outcome was diagnosis billing claim for gout or pharmacy claim for drugs used in treatment of gout as allopurinol or colchicine.
The study showed that African American are at higher risk for post donation gout when compared to Caucasians, it was also more common in elderly and male donors.
It showed that living donors have lower rate of gout when compared to general population early after donation but similar rates during later observation.
The risk of gout was higher in donors when compared with nondonors with similar baseline health.
Donors with gout had higher rate of renal complications post donation compared to matched donors without gout.
Previous studies in general population showed that African American have higher risk of gout compared to Caucasians and this may be attributed to higher risk of gout after donation.
Higher risk of renal impairment was observed among African Americans compared to Caucasians and is multi-factorial
The study suggest the need for long term post donation follow up and access to health care for all donors
Limitations:
The study included insured donors only, however, the cohort had similar baseline characteristics as donor population in OPTN.
Pre donation information about gout, baseline information on clinical parameters and information on dietary habits, alcohol intake and over-the-counter medications were not available for all sample.
Diagnosis of gout was based on billing claims
Race information was not available for nondonors.
Level of evidence: 3 Retrospective cohort study
Potential donors are asked about prior history of gout, should be informed about the increased risk after donation and those with prior history of gout should be informed about methods to decrease the risk of future episodes.
Thank you
● Hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population
● African-Americans have a higher risk of gout compared to Caucasians
● Donor subgroups at increased risk of gout include African-Americans, older donors, and men.
● Donors have lower gout rates than general-population non-donors early after donation but similar rates during later observation and higher rates compared to healthy matched non-donor
● A decline in renal function post-donation may lead to hyperuricemia and a predisposition to gout
● Recent studies have identified higher serum uric acid levels in living kidney donors compared to pre-donation levels
● When donors with gout were compared to donors without gout, there were significant increases in the rates of post-donation renal conditions, such as acute kidney injury, CKD, and other disorders of the kidney.
● Uric acid may, itself, contribute to the development and progression of CKD
● Limitation of this study :
** lack of available information on race/ethnicity.these results may not be generalizable to non-Caucasian donors.
** Uninsured living kidney donors are not captured
** Pre-donation benefits were captured for only a minority of the donors (7.7%)
** Information on pre-donation diagnoses, such as gout, was not adequate for inclusion
** lacked baseline information on clinical parameters such as body mass index sufficient for inclusion
** Laboratory values, such as serum uric acid levels and postdonation serum creatinine, and information on dietary habits, alcohol intake, and over-the counter medication use were not available in data sources
** Definition of a diagnosis of gout was based on provider-reported billing claims, rather than joint fluid aspiration for monosodium urate crystals, and may be subject to misclassification
Level evidence : III
Reflect on the guidlines
Kdigo guidlines 2017
■ Donor candidates should be asked about prior episodesof gout.
■ Donor candidates may be informed that donation is associated with an increase in serum uric acid concentration, which may increase the risk for gout.
■ Donor candidates and donors with prior episodes of gout should be informed of recommended methods to reduce their risk of future episodes of gout.
In my practice l don’tnotice hyperuricemia in living donors afterdonation
Thank you
Please summarise this article in your own words
Introduction
Previous studies confirmed that uric acid levels rise early after donor nephrectomy. In recent study from Ontario, Canada, they found that living kidney donors are more likely to be diagnosed with gout compared to healthy matched non-donors. Increase uric acid postdonation may contributes to renal disease
Aim of the study
Identification of post-donation gout, investigate possible variations within donors according to demographic traits including race and compare rates of renal conditions among matched donors with and without gout
Methods
Using database that integrates national registry identifiers of U.S. living kidney donors (1987-2007) with billing claims from a private health insurer (2000-2007) to assess post-donation gout among living donors, explore possible within-donor demographic variation, compare gout rates among donors and general-population non-donors, and examine renal disease rates among donors with and without gout
Results
The study sample of 4,650 donors included 13.1% African-Americans, 76.3% were Caucasian, 8.2% were Hispanic, and 2.4% were other races
By seven years; African-Americans were almost twice as likely to develop gout as Caucasian donors (4.4% vs. 2.4%). Post-donation gout was three times higher among male compared to female donors. Post-donation gout risk also increased with older age at donation and was higher in men. Gout rates were similar in donors and age- and sex-matched general non-donors. Compared to matched donors without gout, donors with gout had more frequent renal diagnoses, reaching significance for AKI, CKD, and other disorders of the kidney. Renal diagnosis rates among living kidney donors with gout did not differ significantly from that of non-donors with gout
Limitations:
1. Data only from a private insurance (uninsured living kidney donors were not included)
2. Information on pre-donation diagnoses ( such as gout) was not adequate for inclusion)
3. No baseline information on clinical parameters such as BMI
4. No data for laboratory values (serum uric acid levels and post- donation serum creatinine), dietary habits, alcohol intake, and over-the- counter medication
5. No race information for non-donors
Conclusion
Donor subgroups at increased risk of gout include African- Americans, older donors, and men
Donors with gout also appear to have a higher burden of post-donation renal complications after demographic adjustment
Further studies should examine whether the direct impacts of donation on the risk and consequences of gout differ according to demographic traits
What is the level of evidence provided by this article?
Level 2 (retrospective cohort study)
Please reflect on the guidelines and refer to your practice
Screen donors of high risk gout (family history, high BMI, HTN, older age and black)
No clear association between donation and gout
Thank you
Summary of the article
There are many limitations of the current study:
Level of evidence: Level 3
KDIGO guidelines state that donor candidates may be informed that donation is associated with an increase in serum uric acid concentration, which may increase the risk for gout. So, these candidates should be recommended methods to reduce risk of gout.
Reflection on practice:
We would ask donors history of gout and see their serum uric acid levels, counsel them for high-risk post-donation gout.
We would follow-up them strictly to rule out renal diseases in them.
Thank you
A decline in renal function results in less uric acid excretion and higher levels of serum uric acid contributing to a higher risk of gout in patients with chronic kidney disease.
Kidney donors with remaining single kidney post nephrectomy, have lower kidney function and may be at risk to have higher uric acid levels.
Meta-analysis found that hyperuricemia was an independent predictor of newly diagnosed CKD in the non-CKD population.
One study showed that, living kidney donors were more likely to be diagnosed with gout compared to healthy matched non-donors and were more likely to receive a prescription for a medication typically used to treat gout.
Study design and primary outcome
A retrospective cohort study was conducted using linked healthcare databases in the U.S. to ascertain patient characteristics, covariate information, and outcome events.
They included living kidney donors who had donated between October 1987 and July 2007 and were enrolled in the insurance benefit plan at some point after donation during May 2000 to December 2007.
The primary outcome was a composite of the first diagnostic billing claim for gout or pharmacy claim for a medication typically used to treat gout.
Results
Level of evidence : retrospective cohort level 3 of evidence.
Thank you
Summary:
There is relation between serum uric acid and chronic kidney disease as hyperuricemia can cause CKD and hyperuricemia is usually associated with reduced excretion of uric acid and causes subsequent hyperuricemia. So, hyperuricemia is a predictor of CKD.
This is a retrospective cohort study with control group evaluating 4,650 donors, of which 609 are African-Americans. Post-donation gout identified based on medical diagnosis codes or pharmacy fills for gout therapies and compared with control group.
African-Americans, male and older donors are associated with higher risk of post-donation gout and associated with higher adverse renal outcome.
Reflection of guidelines in my practice:
I routinely follow serum uric acid level in my practice
Level of evidence: level 3
Thank you, but this is a very short summary. Looks like you read the abstract only.
Please write a good summary as always expected from you
Gout after living kidney donation: Correlations with demographic traits and renal complications.
Introduction
Methods
Results
Conclusion
adjustment.
What is the level of evidence provided by this article?
The level of evidence 3 retrospctive Corhot study.
Please reflect on the guidelines and refer to your practice.
Thank you