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


Although hyperuricemia is associated with a number of conditions such as CKD, hypertension, obesity, diabetes and cardiovascular disease,[15] gout is considered the main clinical consequence. Until recently, it was reasonably common (although not guideline recommended) to treat patients with CKD and asymptomatic hyperuricemia with allopurinol as epidemiological studies suggested a benefit in slowing progression of CKD.[16] Others have concluded that serum uric acid (SUA) does not impact on the risk of CKD.[17] The recent CKD-FIX and PERL studies showed that a sustained reduction of urate with allopurinol was not effective at delaying progression of CKD in those with stage 3 CKD and higher.[18,19] Low-quality data suggest possible superiority of febuxostat over allopurinol for preventing CKD progression from hyperuricemia.[20] Currently, expert guidelines recommend managing hyperuricemia only in the context of recurrent attacks of gout, Table 1.