Uric Acid and Chronic Kidney Disease

The prevalence of hyperuricemia is high among people with chronic kidney disease (CKD), increasing significantly as kidney disease progresses. Whether this is an association or a cause-and-effect relationship remains controversial. While evidence strongly supports the treatment of symptomatic hyperuricemia in people with CKD, the evidence supporting the treatment of asymptomatic hyperuricemia is mixed. Some studies show that treatment retards CKD progression, while others do not. In this review, we discussed uric acid metabolism, its association with CKD, and the use of uric acid-lowering agents. We also examined studies conducted to determine whether treating hyperuricemia is beneficial. We hope to provide nephrologists with the knowledge and confidence to confront hyperuricemia, specifically addressing management of asymptomatic hyperuricemia, the differences among society guidelines worldwide, which urate-lowering drugs should be chosen, the role of non-pharmacological therapy in patients with CKD, and the need to minimize the use of medications that may increase uric acid levels.