title: Hyperuricaemia, chronic kidney disease, and outcomes in heart failure: potential mechanistic insights from epidemiological data.
abstract: OBJECTIVE
  To determine if the association between hyperuricaemia and poor outcomes in heart failure (HF) varies by chronic kidney disease (CKD).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Athens, Athens, Greece. geros@otenet.gr
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
authors.forename: James D
authors.initials: JD
authors.lastname: Gladden
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Paul W
authors.initials: PW
authors.lastname: Sanders
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D033461:Hyperuricemia / Q000150:complications* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D057216:Propensity Score; D016032:Randomized Controlled Trials as Topic; D014481:United States / Q000453:epidemiology; D014969:Xanthine Oxidase / Q000378:metabolism
chemical_list: D014969:Xanthine Oxidase