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 chronickidney disease (CKD), primarily due to reduced renal urateexcretion. Elevated serum uric acid (SUA) levels have beenlinked with CKD progression, cardiovascular disease, andmortality. However, association does not imply causation.Over the last decade, multiple studies have failed todemonstrate a renoprotective or cardiovascular benefit ofurate-lowering therapy (ULT) in patients withasymptomatic hyperuricaemia. Consequently, majorinternational societies, including Kidney Disease:Improving Global Outcomes (KDIGO), the AmericanCollege of Rheumatology (ACR), and the European Allianceof Associations for Rheumatology (EULAR), recommendagainst pharmacologic treatment of asymptomatichyperuricaemia, including in patients with CKD. This reviewsynthesizes current guideline recommendations,randomized clinical trial evidence, and practical clinicalconsiderations to delineate scenarios in which ULT shouldnot be initiated in patients with chronic kidney disease,while highlighting the importance of supportive and nonpharmacologicmanagement strategies.Keywords: Hyperuricaemia, Chronic kidney disease,Asymptomatic hyperuricaemia, Urate-lowering therapy,Allopurinol, Febuxostat, Gout