BACKGROUND: Hyperuricemia and gouty arthritis are prevalent in patient with chronic kidney disease (CKD). Few prospective studies have evaluated the possible factors affecting the clinical outcomes of CKD patients with tophaceous gout. METHODS: This is a prospective observational study evaluating renal progression and all-cause mortality in a selected cohort of patients. All non-diabetic patients from different CKD stages who participate the multidisciplinary pre-dialysis education (MPE) program of Chang Gung Memorial Hospital at Keelung were enrolled in this study. All patients were followed-up to September 2011 and noted with clinically poor outcomes (defi ned as renal progression requiring dialysis or all-cause mortality). RESULTS: A total of 138 patients were enrolled in the study. Sixteen (11.59%) of these patients (death: 7 and renal progression: 9) had poor outcomes after a mean follow-up of 34 ± 15 months. Cox regression analysis followed by multivariate analysis showed that high serum creatinine, low hemoglobin (Hb), high systolic blood pressure (SBP) and low waist circumference were associated with poor outcomes independent of age, gender, albumin levels, serum uric acid, calcium, phosphorus, estimated glomerular fi ltration rate, and body-mass index (BMI). CONCLUSION: Serum creatinine, Hb, SBP and waist circumference may help in predicting the risk of poor outcomes in CKD patients with gouty arthritis.