How do you manage persistent hyperuricemia in a patient with CKD3 and type 2 diabetes who has had severe reactions to both allopurinol (SJS) and febuxostat (drug rash), but only a single prior gout flare?

I would just recommend conservative management in this scenario.

Unclear if there is an overneed to initiate any uricosuric agents in this scenario, given just single gout flare.

If there was a history of uric acid stones, then would consider an alternative but that would be challenging, given cannot use a uricosuric agent like probenecid, and agents like pegloticase are used primarily for recalcitrant gout.

So in this case, dietary management and weight management would be primary considerations, and yes, an SGL2 inhibitor can be considered as well.