title: Uric acid renal excretion and renal insufficiency in decompensated severe heart failure.
abstract: 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.
authors.affiliation: 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.
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Ochiai
authors.forename: Antonio C P
authors.initials: AC
authors.lastname: Barretto
authors.forename: Múcio T
authors.initials: MT
authors.lastname: Oliveira
authors.forename: Robinson T
authors.initials: RT
authors.lastname: Munhoz
authors.forename: Paulo C
authors.initials: PC
authors.lastname: Morgado
authors.forename: José A F
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D051437:Renal Insufficiency / Q000453:epidemiology / Q000503:physiopathology*; D014527:Uric Acid / Q000097:blood / Q000378:metabolism* / Q000652:urine
chemical_list: D014527:Uric Acid