ArticleBMC nephrology2026
Gout flare burden as a marker of chronic kidney disease risk.
Article in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundGout is a common inflammatory arthritis with substantial cardiometabolic and renal comorbidity. Although hyperuricemia and baseline kidney function are established predictors of chronic kidney disease (CKD), the prognostic value of long-term gout flare frequency is unclear. This study aimed to examine the association between annual gout flare frequency and the risk of incident CKD.
methodsWe conducted a large-scale retrospective cohort study using de-identified electronic health record data from the TriNetX Global Collaborative Research Network. Adults with at least one treated gout flare in 2017 and preserved baseline renal function (eGFR ≥ 60 mL/min/1.73 m²) were included. Exposure was defined by the annual frequency of treated gout flares. The primary outcome was incident CKD stage 3–5 or end-stage renal disease (ESRD). To minimize reverse causation, a 180-day lag period was applied before the start of follow-up. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for incident CKD over a 7-year follow-up period, adjusting for age, sex, comorbidities (hypertension, diabetes, heart disease, obesity), and urate-lowering therapy use.
resultsAmong 29,321 eligible adults, a higher annual gout flare frequency was independently associated with an increased risk of incident CKD in a graded, dose-dependent manner. Compared with individuals experiencing one flare per year, the risk of incident CKD was significantly higher among those with ≥ 5 flares per year, with aHRs ranging from approximately 1.20 to 1.46 across follow-up years. In contrast, experiencing two flares per year did not confer a statistically significant increase in risk relative to the reference group. Risk separation was evident by year 3 and persisted throughout the 7-year observation period.
conclusionsRecurrent gout flares are associated with a progressively increased risk of incident CKD, suggesting that flare frequency serves as a pragmatic, patient-centered prognostic marker for long-term renal risk assessment. These findings underscore the importance of optimizing flare prevention and urate-lowering strategies in high-risk populations to potentially mitigate adverse renal outcomes.
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