Management of Gout and Hyperuricemia in CKD

Abstract

Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). While the presence of CKD poses additional challenges in gout management, effective urate-lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, while incremental dose escalation is guided by regular monitoring of serum urate to reach the target of less than 6 mg/dL (or less than 5 mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbidities. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.