The role of the estimated glomerular filtration rate and body roundness index in the risk assessment of uric acid-lowering therapy-resistant gout in U.S. adults: evidence from the National Health and Nutrition Examination Survey (2007-2018).

Objective: To explore the risk factors for uric acid-lowering therapy-resistant gout (UALT-RG) and its relationships with the estimated glomerular filtration rate (eGFR), body roundness index (BRI), and visceral adiposity index (VAI) via 2007-2018 National Health and Nutrition Examination Survey (NHANES) data.

Methods: We calculated the BRI using waist circumference and standing height; the VAI using triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and body mass index (BMI); and the eGFR from serum creatinine levels. We also collected gout data. We explored the relationships of the eGFR, BRI, and VAI with UALT-RG risk via univariable and multivariable weighted logistic regression, trend analysis, and restricted cubic splines.

Results: Among the 1,811 patients with gout, ∼9.08% had UALT-RG; these patients were more likely to have obesity, comorbid diabetes (36% [27-47%] vs. 25% [22-28%]) or impaired kidney function (eGFR < 60 mL/min/1.73 m², 34.5% [27-43%] vs. 22.5% [20-26%]); be former smokers; and take colchicine (10% [5.6-19%] vs. 4.3% [2.8-6.7%]). Logistic regression and trend analysis suggested that an elevated BRI and decreased eGFR were independent risk factors and potential screening indicators for UALT-RG. Restricted cubic spline analysis revealed a negative linear trend between the eGFR and UALT-RG risk (p-overall < 0.0001) and a significant positive correlation between the BRI and UALT-RG risk (p-overall < 0.0001).

Conclusion: An increased BRI and decreased eGFR may be independent risk factors and assessment indicators for UALT-RG in U.S. adults. It is necessary to monitor serum urate levels more closely and conduct early multidisciplinary comanagement when gout is comorbid with visceral obesity and chronic kidney disease stages 3-5.