Reconsidering Urate-Lowering Therapy in Chronic Kidney Disease- Guideline Driven Perspectives on the Management of Asymptomatic Hyperuricaemia

Abstract

Hyperuricaemia is highly prevalent in patients with chronic
kidney disease (CKD), primarily due to reduced renal urate
excretion. Elevated serum uric acid (SUA) levels have been
linked with CKD progression, cardiovascular disease, and
mortality. However, association does not imply causation.
Over the last decade, multiple studies have failed to
demonstrate a renoprotective or cardiovascular benefit of
urate-lowering therapy (ULT) in patients with
asymptomatic hyperuricaemia. Consequently, major
international societies, including Kidney Disease:
Improving Global Outcomes (KDIGO), the American
College of Rheumatology (ACR), and the European Alliance
of Associations for Rheumatology (EULAR), recommend
against pharmacologic treatment of asymptomatic
hyperuricaemia, including in patients with CKD. This review
synthesizes current guideline recommendations,
randomized clinical trial evidence, and practical clinical
considerations to delineate scenarios in which ULT should
not be initiated in patients with chronic kidney disease,
while highlighting the importance of supportive and nonpharmacologic
management strategies.
Keywords: Hyperuricaemia, Chronic kidney disease,
Asymptomatic hyperuricaemia, Urate-lowering therapy,
Allopurinol, Febuxostat, Gout