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Uric acid renal excretion and renal insufficiency in decompensated severe heart failure.
MedLine Citation:
PMID:  15921781     Owner:  NLM     Status:  MEDLINE    
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 microg/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 micromol/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 microg/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.
Marcelo E Ochiai; Antonio C P Barretto; Múcio T Oliveira; Robinson T Munhoz; Paulo C Morgado; José A F Ramires
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of heart failure     Volume:  7     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-05-30     Completed Date:  2005-09-27     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  468-74     Citation Subset:  IM    
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.
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MeSH Terms
Heart Failure / epidemiology,  metabolism*,  mortality,  physiopathology
Middle Aged
ROC Curve
Renal Insufficiency / epidemiology,  physiopathology*
Uric Acid / blood,  metabolism*,  urine
Reg. No./Substance:
69-93-2/Uric Acid

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