1. Hyperuricaemia, chronic kidney disease, and outcomes in heart failure: potential mechanistic insights from epidemiological data.
- Author
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Filippatos GS, Ahmed MI, Gladden JD, Mujib M, Aban IB, Love TE, Sanders PW, Pitt B, Anker SD, and Ahmed A
- Subjects
- Aged, Canada epidemiology, Chronic Disease, Female, Glomerular Filtration Rate physiology, Heart Failure blood, Heart Failure mortality, Hospitalization statistics & numerical data, Humans, Hyperuricemia mortality, Kaplan-Meier Estimate, Kidney Diseases blood, Kidney Diseases mortality, Male, Middle Aged, Multicenter Studies as Topic, Prognosis, Propensity Score, Randomized Controlled Trials as Topic, United States epidemiology, Xanthine Oxidase metabolism, Heart Failure etiology, Hyperuricemia complications, Kidney Diseases complications
- 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.
- Published
- 2011
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