How would you manage a patient with non-tophaceous gout with renal insufficiency who previously failed allopurinol and now has a serum urate > 7 despite while on febuxostat 80 mg daily?

Provided the patient is compliant with the current Uloric dose of 80 mg daily and has ongoing flares (symptomatic), options are:

1) Trial increasing dose of Uloric to 120 mg daily which is off label in the US (approved in European and other countries even in patients with moderate CKD, less defined ...