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


There is a rising prevalence of gout around the world and increasing data noting an association between hyperuricemia and gout with progression of CKD. All patients with recurrent, severe or tophaceous gout should be commenced on early ULT with a treat-to-target approach to achieve target serum urate levels less than 6 mg/dl (360 μmol/l). Choice of ULT depends largely on patient comorbidities, ease of access and cost. In the CKD population, allopurinol remains the first-line ULT agent and should be started at low dose with up titration every 2–4 weeks per SUA target. If this is insufficient to achieve target serum urate concentrations, other pharmacotherapy agents are available depending on the patients' kidney function and the slow dose up-titration rule also generally applies. More research is required to establish whether treatment of asymptomatic hyperuricemia has clinical benefits in slowing progression of CKD but a similar approach to ULT dosing may be applicable.