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Living kidney donors more likely to receive a diagnosis of gout compared to healthy non-donors

March 31, 2015 Toronto

Nearly 30,000 people become living kidney donors worldwide each year. Researchers at the Institute for Clinical Evaluative Sciences (ICES) and Lawson Health Research Institute have found that donating a kidney modestly increases an individual’s absolute long-term incidence of gout.

Gout — a complex form of arthritis — is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. It is caused by elevated levels of uric acid in the blood. Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

"We wanted to find out if donating a kidney increases a living donor's risk of gout since the serum concentration of uric acid rises in donors after nephrectomy. We recommend this unique observation be corroborated in future studies before it is routinely shared with potential donors and their recipients as part of the informed consent process," said Dr. Ngan Lam, lead author, nephrologist and post-doctoral fellow at ICES Western.

The retrospective matched cohort study, published in the American Journal of Kidney Diseases, looked at 1,988 living kidney donors who donated between 1992 and 2010 from Ontario and compared them to 19,880 healthy non-donors using linked administrative databases at ICES. Living kidney donors were more likely to receive a diagnosis of gout compared to healthy non-donors (3.4 per cent vs. 2.0 per cent). Donors were also more likely to receive a prescription for medications typically used to treat gout, such as allopurinol or colchicine, compared to healthy non-donors (3.8 per cent vs. 1.3 per cent).

The researchers stress that the absolute increase in the incidence of gout is reassuringly small and is unlikely to deter potential living kidney donors, recipients, or transplant programs from proceeding with donation.

“Living kidney donation is an important treatment option for kidney failure that clearly benefits many families and society. We are reassured that the increased likelihood of a person developing gout after donating a kidney is not substantial,” said author Dr. Amit Garg, director of Living Kidney Donation and a kidney specialist at the London Health Sciences Centre (LHSC), a researcher at Lawson and ICES, and a professor of medicine and epidemiology & biostatistics at Western University.

A better understanding of the long-term outcomes for living kidney donors is needed to improve the informed consent process for donors and recipients and to maintain the integrity and safety of this life-saving practice.

“Gout After Living Kidney Donation: A Matched Cohort Study,” was published in the American Journal of Kidney Diseases.

Author block: Ngan N. Lam, Eric McArthur, S. Joseph Kim, G. V. Ramesh Prasad, Krista L. Lentine, Peter P. Reese, Bertram L. Kasiske, Charmaine E. Lok, Liane S. Feldman, Amit X. Garg on behalf of the Donor Nephrectomy Outcomes Research (DONOR) Network.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

For the latest ICES news, follow us on Twitter: @ICESOntario

This work was done by the new provincial ICES Kidney, Dialysis and Transplantation Research Program.

Lawson Health Research Institute. As the research institute of London Health Sciences Centre and St. Joseph's Health Care London, and working in partnership with Western University, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world. www.lawsonresearch.com

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