Hyperuricemia in patients with chronic kidney disease: When and what to treat?

Hyperuricemia is frequently associated with gout, renal disease, arterial hypertension and high cardiovascular disease. All CKD patients with a first episode of gout should be treated with hypouricemic drugs to achieve baseline UA levels of less than 6 mg/dl (< 5 mg/dl if tophi are present). The hypouricemic drugs of choice in patients with CKD are allopurinol and febuxostat, always starting treatment with low doses that can be progressively increased according to tolerance. Asymptomatic hyperuricemia increases the risk of arterial hypertension, cardiovascular disease and renal disease, but at present published clinical trials do not support the treatment of asymptomatic hyperuricemia in patients with CKD.