The management of gout in patients with chronic kidney disease (CKD) can be challenging due to multiple factors. These include limitations on the type or doses of medications used. Although limitations or exclusions of some treatment options are warranted, others that are traditionally followed, such as the doses used for urate-lowering therapies such as allopurinol or febuxostat, may lead to undertreatment of gout. In this review, guidelines from consensus groups are discussed with a focus on management of gout in patients with CKD and appropriate dose adjustments beyond traditional kidney-dosed limits.