Asymptomatic hyperuricemia: which patient should be treated?: a review

Abstract

Background: Patients with Asymptomatic Hyperuricemia (AHU) are often unnecessarily and almost systematically treated with Urate-Lowering Therapy (ULT), risking severe and sometimes fatal adverse effects. While symptomatic HU is almost always easily diagnosed and treated, ULT in AHU remains controversial. We performed a literature review to determine which patient should be treated, in light of the lack of consensus guideline. In fact, recommendations are still controversial regarding indications of ULT in asymptomatic hyperuricemia patients. Relevant databases were searched, and eligible trials were assessed.
Objective: The aim of this review was to present data on when ULT treatment should be initiated.
Data source: A literature search in Pub Med.
Results: Current research remains controversial. While non-pharmacological therapy with diet restriction and exercise is recommended for all patients with AHU, further studies identifying guideline for the ULT for AHU would be beneficial. However, some practical key points are to consider: ULT is not likely to slow Chronic Kidney Disease (CKD). Consequently, patients with better preserved renal function and children, might benefit more from an early ULT. However, more studies are needed to investigate if ULT decelerates GFR decline and progression to CKD (especially Stages III-V) and if patients with CKD benefit from ULT. Maintain lifelong serum uric acid levels lower than 6mg/dL for patients at high cardiovascular risk and the target level should be 5mg/dL. Allopurinol is recommended as a first-line ULT. To this end, we propose a practical algorithm for the management of AHU and hope that our work will be useful in making therapeutic decision.