Can we crystallize the role of urate-lowering treatment in chronic kidney disease?

The therapeutic value of serum urate lowering in chronic kidney disease is questionable given the lack of clinical benefit from randomized clinical trials. Post hoc analysis of the CARES (Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities) trial suggests a protective effect of urate lowering in gout participants over 2.5 years of follow-up with the greatest benefit for those who maintained average urate levels of <6 mg/dl. A shift in research focus from asymptomatic hyperuricemia to symptomatic hyperuricemia may yet yield dividends.