Managing Hyperuricemia and Gout in Chronic Kidney Disease

A Clinical Conundrum

Kulanka H. Premachandra; Richard O. Day; Darren M. Roberts


Curr Opin Nephrol Hypertens. 2021;30(2):245-251. 

In This Article

Importance to Nephrologists

A recent systematic review and meta-analysis of epidemiological and observational studies suggest that the overall prevalence of CKD [stage 3 or greater; glomerular filtration rate (GFR) < 60 ml/min/1.73 m2] in patients with gout is 24% compared with 8% in patients without gout.[12] It is uncertain whether hyperuricemia and gout are causative factors in the development of CKD, or if they are consequences of impaired kidney function.[13,14]

While there is consensus among international guidelines on the general approach to managing gout, there are discrepancies or limited advice in the context of CKD, Table 1. In recent years, there has been research looking in to alternative second-line and third-line pharmacotherapies in CKD. Despite this, however, there is still a great need for research on the impact of these agents in the context of various degrees of CKD.

It is also important to differentiate asymptomatic hyperuricemia from gout as evidence for their management differs. Many studies have demonstrated a link between hyperuricemia and CKD (and the cause–effect relationship has been debated) but the impact of urate lowering treatment (ULT) has had mixed results in published research.