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Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study

Journal article
Authors Anton J. Landgren
Lennart T. H. Jacobsson
Ulf Lindström
Tatiana Zverkova Sandström
Panagiota Drivelegka
Lena Björkman
E. Fjellstedt
Mats Dehlin
Published in Arthritis Research & Therapy
Volume 19
ISSN 1478-6354
Publication year 2017
Published at Institute of Medicine, Department of Rheumatology and Inflammation Research
Language en
Keywords Epidemiology, Gout, Incidence, Predictors, Nephrolithiasis, uric-acid nephrolithiasis, kidney-stones, national-health, epidemiology, prevalence, management, urolithiasis, pathophysiology, hyperuricemia, allopurinol, Rheumatology
Subject categories Rheumatology and Autoimmunity


Background: Nephrolithiasis (NL) is known to be associated with gout, although there are few comparative studies on risk and risk factors for NL in gout compared to population cohorts. In this cohort study we investigated: (1) overall incidence of NL in gout (cases) and general population controls; (2) risk and risk factors (common comorbidities and medications) for first-time NL in cases and controls separately. Methods: Cases (n = 29,968) and age-matched and sex-matched controls (n = 138,678) were identified from the regional healthcare database in western Sweden (VEGA). The analyzed risk factors (comorbidities and current medication use) for first-time NL, and socioeconomic factors were retrieved from VEGA and other national Swedish registers. For cases, follow up began on 1 January 2006 or on the first diagnosis of gout if this occurred later, and for controls on their index patient's first diagnosis of gout. Follow up ended on death, emigration or 31 December 2012. Incidence rates (IR) per 1000 person-years and hazard ratios (HR) were calculated. The incidence calculations were performed for cases (regardless of prior NL) and their controls. HRs with first occurrence of NL as outcome were calculated only in those without previous NL. Results: In cases there were 678 NL events (IR: 6.16 events per 1000 person-years (95% CI: 5.70-6.64) and in controls 2125 NL events (IR 3.85 events per 1000 person-years (95% CI: 3.69-4.02), resulting in an age-sex-adjusted incidence rate ratio of 1.60 (95% CI: 1.47-1.74). Point estimates for predictive factors were similar in cases and controls, except for a significant interaction for losartan which increased the risk of NL only in controls (HR = 1.49 (95% CI: 1.03-2.14). Loop diuretics significantly decreased the risk of NL by 30-34% in both cases and controls. Further significant predictors of NL in gout cases were male sex, diabetes and obesity and in controls male sex and kidney disease. Conclusions: The risk (age and sex adjusted) of NL was increased by 60% in cases compared to controls. None of the commonly used medications increased the risk of NL in gout patients.

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