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Uric acid renal excretion and renal insufficiency in decompensated severe heart failure
Author(s) -
Ochiai Marcelo E.,
Barretto Antonio C.P.,
Oliveira Múcio T.,
Munhoz Robinson T.,
Morgado Paulo C.,
Ramires José A.F.
Publication year - 2005
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2004.09.018
Subject(s) - medicine , uric acid , hyperuricemia , decompensation , creatinine , heart failure , renal function , ejection fraction , excretion , endocrinology , acute decompensated heart failure , gastroenterology , urology , cardiology
Objective To evaluate uric acid renal excretion, hyperuricemia, renal dysfunction, and prognosis in patients with decompensated severe heart failure, as there are few data available. Methods One hundred and twenty‐two patients, hospitalized for heart failure decompensation, in NYHA class IV, were classified into 3 groups as follows. Pilot group [ejection fraction (EF)≤0.45, n =16], group 1 (EF≤0.45, n =90), and group 2 (EF>0.45 and valvular dysfunction, n =16). The patients in groups 1 and 2 underwent assessment of creatinine and uric acid clearance before and after pyrazinamide, to estimate uric acid tubular secretion. Uric acid clearance <6.8 mL/min and secretion <170 μg/min were considered reduced. In groups 1 and pilot ( n =106), mortality was analyzed by Cox regression model, and the prognostic value of hyperuricemia was assessed by ROC curve. Results In groups 1 and 2, respectively, serum uric acid was 511.7 and 422.5 mol/L, and creatinine clearance was 46.7 and 61.4 mL/min. Uric acid clearance (3.2 vs. 3.9 mL/min) and tubular secretion (116 vs. 128 μg/min) were not different, but lower than normal values. In groups 1 and pilot, the 12‐month mortality was 46.4% (CI 95%: 36.7%−56.0%). At end of follow‐up, mortality was associated with impaired creatinine clearance ( p <0.001), but not with hyperuricemia ( p =0.236). Conclusions In patients with decompensated severe heart failure, the tubular secretion and the clearance of uric acid were reduced. Renal dysfunction was associated with mortality, but hyperuricemia was not.