Lower serum albumin levels and worsening secondary hyperparathyroidism were also associated with greater likelihood of gout [OR 1.09 (1.03–1.14) per 1 g/dL decrease in albumin, and OR 1.33 (1.14–1.56) per 50 pg/mL increase in PTH, all p <0.005. Here, ALB is linked to secondary hyperparathyroidism.