[Hyperuricemia in Chronic Kidney Disease: To Treat or Not to Treat?]

Numerous studies have shown that hyperuricemia (HU) is an independent risk factor for the development of chronic kidney disease (CKD) and cardiovascular events. However, while some evidence suggests that uric acid (UA) may play not only a predictive but also a causal role in these conditions, a robust and definitive demonstration of this is still lacking. Moreover, despite what appears to be a logical rationale supporting the use of so-called 'urate-lowering therapy' (ULT) for nephroprotection in hyperuricemic patients with CKD, studies and meta-analyses on this topic - sometimes burdened by limitations that may have affected their results - have so far provided highly divergent outcomes, leaving uncertainty about whether drug-induced reduction of uricemia can truly slow the progression of CKD and prevent its cardiovascular complications. This article summarizes current knowledge on UA metabolism and the drugs that interfere with it, discusses theories on the possible multiple pathogenic mechanisms underlying HU related kidney damage, and reviews the results and limitations of the most recent studies that have supported or refuted the nephroprotective role of ULT in CKD, fueling an ongoing scientific controversy.