When does asymptomatic hyperuricemia need treatment?

Summary. Relevance. The definition and management of asymptomatic hyperuricemia has been an area of controversy for many decades. Debate persists regarding the benefit of treating different cases of asymptomatic hyperuricemia. The aim of the study was to analyze existing information on management of asymptomatic hyperuricemia. Material and methods. It were held an overview of modern literature on management of the asymptomatic hyperuricemia. Results and discussion. Hyperuricemia may be a cause or a consequence of a comorbidity. Whereas epidemiological studies suggest that hyperuricemia may be linked to cardiovascular, metabolic, and renal comorbidities, Mendelian randomization studies have not provided proof that these links are causal. The lack of data on the potential benefits of urate-lowering therapy preclude the development of recommendations for asymptomatic hyperuricemia in comorbidities. Selection of urate-lowering therapy must be based on data on risk of gout development, that estimated at 50%, and on the other hand — risk of cutaneous and cardiovascular side effects of urate-lowering medicines — xanthine oxidase inhibitors. Conclusion. There is wide variety of data on the benefits of urate-lowering therapy (febuxostat) in asympto­matic hyperuricemia associated with chronic kidney disease. The need for optimal comorbidity management, in contrast, is universally accepted. Medications for comorbidities that elevate urate le­vels should be discontinued and replaced with medications that haven’t such effect.