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1. Asymptomatic Hyperuricemia with CKD
To Treat or Not To Treat
Mohammed Abdel Gawad MD Neph, ESENeph
Lecturer of Nephrology, School of Medicine, New Giza University
Nephrology Consultant, Alexandria
Founder of NephroTube.com
Co-chair of AFRAN Web/Media Committee
ISN Education SoMe Team Member
drgawad@gmail.com
@Gawad_Nephro

3. Chronic symptomatic
hyperuricemia / Gout /
Nephrolithiasis
CKD ND
Treat hyperuricemia:
life style +
urate lowering therapy (ULT)
CKD
Chronic symptomatic
hyperuricemia / Gout
/ Nephrolithiasis
Treat hyperuricemia:
life style + urate
lowering therapy (ULT)
Chronic
symptomatic
hyperuricemia
Asymptomatic
hyperuricemia
?? ULT: to use or
not to use
CKD ND
life style

4. Chronic
symptomatic
hyperuricemia
Asymptomatic
hyperuricemia
?? ULT: to use or
not to use
CKD ND
• Available evidence and its appraisal:
• Guidelines
• Trials / Studies
• Special situations
• Proposed approach
Conflicting and contradictory results

5. Chronic
symptomatic
hyperuricemia
Asymptomatic
hyperuricemia
?? ULT: to use or
not to use
CKD ND
• Available evidence and its appraisal:
• Guidelines
• Trials / Studies
• Special situations
• Proposed approach
Conflicting and contradictory results

8. Available online 15 May 2020

10. Chronic
symptomatic
hyperuricemia
Asymptomatic
hyperuricemia
?? ULT: to use or
not to use
CKD ND
• Available evidence and its appraisal:
• Guidelines
• Trials / Studies
• Special situations
• Proposed approach
Conflicting and contradictory results

13. no evidence of
clinically meaningful
benefits of serum
urate reduction
with allopurinol on
kidney outcomes
among patients with
type 1 diabetes and
early-to-moderate
diabetic kidney
disease

14. no evidence of
clinically meaningful
benefits of serum
urate reduction
with allopurinol on
kidney outcomes
among patients with
type 1 diabetes and
early-to-moderate
diabetic kidney
disease
Can PERL study result be generalized to all type 1 DM
CKD patients?

19. Can CKD-FIX study result be generalized to all CKD
with albuminuric or high risk of progression?

22. stage 3 or 4 CKD

23. Patients with progressing
CKD (decrease in eGFR by
>4 ml/min/1.73m2 per
year) over 1–2 years,
empiric allopurinol may be
appropriate

25. Chronic
symptomatic
hyperuricemia
Asymptomatic
hyperuricemia
?? ULT: to use or
not to use
CKD ND
• Available evidence and its appraisal:
• Guidelines
• Trials / Studies
• Special situations
• Proposed approach

26. PERL trial and
CKD-FIX
Young age

27. Non proteinuric, mild to moderate
renal impairment

28. The association between the pre-donation serum UA and residual renal
function at 6 months and 1 year after nephrectomy
291 live kidney donors
Volume 49, Issue 5, June 2017
Solitary kidney

29. Chronic
symptomatic
hyperuricemia
Asymptomatic
hyperuricemia
?? ULT: to use or
not to use
CKD ND
• Available evidence and its appraisal:
• Guidelines
• Trials / Studies
• Special situations
• Proposed approach

31. Home Messages - Asymptomatic hyperuricemia in CKD
• Debatable evidence to treat or not treat
• Scale arm is more toward not to treat
• ?! CKD progression (especially after controlling all other factors/early
CKD), non proteinuric, mild to moderate CKD, young age, solitary
kidney
• Individualization according to step wise approach may be reasonable.

32. Thank You