Gout and hyperuricemia are strongly associated with chronic kidney disease (CKD).1 This is not surprising considering that the majority of uric acid clearance takes place in the kidney.2 Thus, as kidney function declines, serum urate concentrations rise. In the last 2 decades, it has been proposed that asymptomatic hyperuricemia is more than a passive bystander in CKD. Several animal studies linked hyperuricemia to kidney disease progression via a variety of crystal-independent mechanisms, including endothelial dysfunction, systemic and glomerular hypertension, and tubulointerstitial inflammation and damage.