Management of Asymptomatic Hyperuricemia to Prevent Gout and Renal Disease: A Systematic Review

Abstract

Introduction: Whether to treat asymptomatic hyperuricemia to prevent the first gout flare or the progression of chronic kidney disease (CKD) is a common clinical dilemma. This review evaluates the evidence for urate-lowering therapy (ULT) in this population.

Methods: A search for RCTs was conducted. We included studies that randomized individuals with asymptomatic hyperuricemia to receive a ULT (e.g., allopurinol, febuxostat) or placebo/no treatment. Outcomes of interest were incident gout and change in eGFR.

Results: The review included 10 trials. The data showed that ULT significantly reduced the incidence of a first gout flare. However, the studies did not demonstrate a consistent or clinically meaningful benefit of ULT on preserving renal function in patients with CKD.

Discussion: The benefit of ULT in asymptomatic hyperuricemia is primarily limited to gout prevention. The number needed to treat to prevent one gout flare is high, suggesting that this strategy may not be cost-effective for all. There is currently insufficient evidence to support treating asymptomatic hyperuricemia solely for renal protection.

Conclusion: Urate-lowering therapy reduces the risk of incident gout in asymptomatic hyperuricemia but does not clearly prevent CKD progression.