Hyperuricaemia, chronic kidney disease, and outcomes in heart failure: potential mechanistic insights from epidemiological data.

Pubmed ID: 21199831

Pubmed Central ID: PMC3056205

Journal: European heart journal

Publication Date: March 1, 2011

Affiliation: University of Athens, Athens, Greece. geros@otenet.gr

MeSH Terms: Humans, Male, Female, Aged, Multicenter Studies as Topic, United States, Middle Aged, Randomized Controlled Trials as Topic, Chronic Disease, Heart Failure, Hospitalization, Propensity Score, Prognosis, Kaplan-Meier Estimate, Kidney Diseases, Hyperuricemia, Xanthine Oxidase, Glomerular Filtration Rate, Canada

Grants: R01-HL085561, R01-HL097047, P30 DK079337, R01 DK046199-16, R01 DK046199-17

Authors: Ahmed MI, Love TE, Ahmed A, Mujib M, Filippatos GS, Anker SD, Aban IB, Pitt B, Sanders PW, Gladden JD

Cite As: Filippatos GS, Ahmed MI, Gladden JD, Mujib M, Aban IB, Love TE, Sanders PW, Pitt B, Anker SD, Ahmed A. Hyperuricaemia, chronic kidney disease, and outcomes in heart failure: potential mechanistic insights from epidemiological data. Eur Heart J 2011 Mar;32(6):712-20. Epub 2011 Jan 3.

Studies:

Abstract

AIM: To determine if the association between hyperuricaemia and poor outcomes in heart failure (HF) varies by chronic kidney disease (CKD). METHODS AND RESULTS: Of the 2645 systolic HF patients in the Beta-Blocker Evaluation of Survival Trial with data on baseline serum uric acid, 1422 had hyperuricaemia (uric acid ≥6 mg/dL for women and ≥8 mg/dL for men). Propensity scores for hyperuricaemia, estimated for each patient, were used to assemble a matched cohort of 630 pairs of patients with and without hyperuricaemia who were balanced on 75 baseline characteristics. Associations of hyperuricaemia with outcomes during 25 months of median follow-up were examined in all patients and in those with and without CKD (estimated glomerular filtration rate of <60 mL/min/1.73 m(2)). Hyperuricaemia-associated hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality and HF hospitalization were 1.44 (1.12-1.85, P = 0.005) and 1.27 (1.02-1.58, P = 0.031), respectively. Hazard ratios (95% CIs) for all-cause mortality among those with and without CKD were 0.96 (0.70-1.31, P = 0.792) and 1.40 (1.08-1.82, P = 0.011), respectively (P for interaction, 0.071), and those for HF hospitalization among those with and without CKD were 0.99 (0.74-1.33, P = 0.942) and 1.49 (1.19-1.86, P = 0.001), respectively (P for interaction, 0.033). CONCLUSION: Hyperuricaemia has a significant association with poor outcomes in HF patients without CKD but not in those with CKD, suggesting that hyperuricaemia may predict poor outcomes when it is primarily a marker of increased xanthine oxidase activity, but not when it is primarily due to impaired renal excretion of uric acid.