© 2005 European Society of Cardiology
Uric acid renal excretion and renal insufficiency in decompensated severe heart failure
Cotoxó Hospital, Prevention and Rehabilitation Service, Heart Institute (InCor), University of São Paulo Medical School Av. Dr. Enéas de Carvalho Aguiar, 44-CEP 05403-900, São Paulo-SP, Brazil
* Corresponding author. Tel./Fax: +55 11 3069 5417. E-mail address: pereira.barretto{at}incor.usp.br
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Abstract |
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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 (EF0.45, 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.
Key Words: Congestive heart failure • Uric acid • Kidney insufficiency
Received November 7, 2003; Revised July 16, 2004; Accepted September 16, 2004
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