The long-term management of gout with urate-lowering therapy (ULT) in the setting of coexistent kidney disease has been the subject of debate and concern for clinicians for many years. Lack of evidence owing to the systematic exclusion of individuals with chronic kidney disease (CKD) from gout clinical trials and failure to report results of clinical trials stratified by kidney function, combined with clinical concerns, real or perceived, about reduced efficacy of ULT, adverse impacts on kidney function, and increased risk of serious adverse events in the setting of CKD, have all contributed to suboptimal gout management.