Serum Uric Acid Increase through the Treatment of Acute Decompensated Heart Failure Might Predict Adverse Outcome

2017 ◽  
Vol 23 (10) ◽  
pp. S60
Author(s):  
Yuji Nagatomo ◽  
Hironori Yamamoto ◽  
Mayuko Tsugu ◽  
Keitaro Mahara ◽  
Mitsuaki Isobe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Adverse Outcome ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

P5413Effect of empagliflozin as add-on therapy on serum uric acid level in patients with type 2 diabetes hospitalized for acute decompensated heart failure: a prospective randomized controlled study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Tamaki ◽  
T Yamada ◽  
T Morita ◽  
Y Furukawa ◽  
Y Iwasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Acid Level ◽  
Acute Decompensated Heart Failure ◽  
Serum Uric Acid Level ◽  
Decompensated Heart Failure ◽  
Sglt2 Inhibitors ◽  
Lower Serum

Abstract Background Elevated serum uric acid (UA) level has been shown to be associated with reduced survival among patients (pts) with heart failure. Sodium glucose cotransporter 2 (SGLT2) inhibitors have been reported to lower serum uric acid level in pts with type 2 diabetes mellitus (T2D). Empagliflozin, one of the SGLT2 inhibitors, has been shown to reduce the risk of cardiovascular mortality in T2D pts with cardiovascular disease, and involvement of UA lowering effect by empagliflozin in the reduction of cardiovascular mortality has been suggested. However, little is known about the effect of empagliflozin as add-on therapy on serum UA level in T2D pts with acute decompensated heart failure (ADHF). Purpose We sought to elucidate the effect of empagliflozin as add-on therapy on serum UA level in T2D pts with ADHF. Methods We enrolled 38 consecutive T2D pts admitted for ADHF. On admission, enrolled pts were randomly assigned in a 1:1 ratio to either empagliflozin add-on therapy (EMPA(+)) or conventional glucose-lowering therapy (EMPA(−)). All pts in EMPA(+) group received empagliflozin (10 mg/day) throughout the study period. Left ventricular ejection fraction (LVEF) was measured at baseline using echocardiography. Body weight and vital signs, such as blood pressure and heart rate, were measured, and blood and urine samples were collected at baseline and 1, 2, 3 and 7 days after randomization. Renal handling of UA was evaluated by fractional excretion of UA (FEUA). Results Twenty pts were assigned to the EMPA(+) group, and 18 pts were assigned to the EMPA(−) group. There were no significant baseline differences in LVEF, plasma brain natriuretic peptide level, body mass index, or serum creatinine level between the EMPA(+) and EMPA(−) groups. In addition, prevalence rate of hyperuricemia, serum UA level, and FEUA did not significantly differ between the two groups at baseline. However, there was significant difference in the change in serum UA level from baseline at 2, 3 and 7 days after randomization between the two groups (Figure A). As a result, serum UA level was significantly lower in the EMPA(+) group than in the EMPA(−) group at 7 days after randomization (6.2±1.8 mg/dL vs 7.8±1.8 mg/dL, p=0.0127). Moreover, FEUN of the EMPA(+) group was significantly higher at 1, 2 and 7 days after randomization (Figure B), which suggested that serum UA level was lowered in the EMPA(+) group by increased urinary excretion of UA. Figure 1 Conclusions This study demonstrated that empagliflozin as add-on therapy can lower serum UA level in T2D pts with ADHF through the effect on the urinary excretion rate of UA.

scholarly journals On admission serum sodium and uric acid levels predict 30 day rehospitalization or death in patients with acute decompensated heart failure

2017 ◽  
Vol 4 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Ahmad Amin ◽  
Mitra Chitsazan ◽  
Fatemeh Shiukhi Ahmad Abad ◽  
Sepideh Taghavi ◽  
Nasim Naderi
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Serum Sodium ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

Abstract 12854: Uric Acid In-hospital Change Provides the Additional Long-Term Prognostic Information to Acute Kidney Injury in Patients Admitted for Acute Decompensated Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Takahisa Yamada ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
Shunsuke Tamaki ◽  
Yusuke Iwasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Fold Increase ◽  
Decompensated Heart Failure ◽  
Cvd Risk ◽  
Prognostic Information ◽  
Stage 1

Backgrounds: Acute kidney injury (AKI) during heart failure treatment is associated with poor outcome in patients admitted with acute decompensated heart failure (ADHF). In patients with ADHF,increased uric acid (UA) level is also a prognostic marker, but there is no information available on the long-term prognostic significance of UA in-hospital change, relating to AKI in patients admitted for ADHF. Methods and Results: We studied 237 patients admitted with ADHF and discharged with survival. The measurements of serum UA and creatinine (Cr) levels were repeated during hospitalization, and the change of UA was obtained by subtracting the value at admission or discharge from the maximum value. AKI was defined according to AKI Network criteria (stage 1, ≥0.3mg/dl absolute or 1.5-to 2.0-fold relative increase in Cr; stage 2, >2- to 3-fold increase in Cr; stage 3, >3-fold increase in Cr or Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.3±3.3 yrs, 59 patients had cardiovascular death (CVD). At multivariate Cox analysis, UA change (p=0.02) and stage 2 or 3 AKI (p=0.01) were significantly associated with CVD, independently of age, systolic blood pressure, serum sodium, hemoglobin, UA and Cr levels, although stage 1 AKI showed no significant association with CVD. Patients with both higher degree of UA change (top quartile:≥4.4 mg/dl) and stage 2 or 3 AKI had a significant increased CVD risk, compared to patients with either higher UA change or stage 2 or 3 AKI (75% vs 34%, p=0.006, hazard ratio 3.8[95%CI 1.4-8.6]). Furthermore, patients with either higher UA change or stage 2 or 3 AKI also had a significant increased CVD risk, compared to patients with none of these two variables (34% vs 19%, p=0.01, hazard ratio 2.0[95%CI 1.1-3.5]). Conclusion: Uric acid in-hospital change could provide the additional long-term prognostic information to moderate to severe AKI in patients admitted for ADHF.

scholarly journals Relationship of hyperuricemia with mortality in heart failure patients with preserved ejection fraction

2015 ◽  
Vol 309 (7) ◽  
pp. H1123-H1129 ◽  
Author(s):  
Takeshi Shimizu ◽  
Akiomi Yoshihisa ◽  
Yuki Kanno ◽  
Mai Takiguchi ◽  
Akihiko Sato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Ejection Fraction ◽  
Serum Uric Acid ◽  
Decompensated Heart Failure ◽  
Cardiopulmonary Exercise Test ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
All Cause Mortality ◽  
The Impact

Serum uric acid is a predictor of cardiovascular mortality in heart failure with reduced ejection fraction. However, the impact of uric acid on heart failure with preserved ejection fraction (HFpEF) remains unclear. Here, we investigated the association between hyperuricemia and mortality in HFpEF patients. Consecutive 424 patients, who were admitted to our hospital for decompensated heart failure and diagnosed as having HFpEF, were divided into two groups based on presence of hyperuricemia (serum uric acid ≥7 mg/dl or taking antihyperuricemic agents). We compared patient characteristics, echocardiographic data, cardio-ankle vascular index, and cardiopulmonary exercise test findings between the two groups and prospectively followed cardiac and all-cause mortality. Compared with the non-hyperuricemia group ( n = 170), the hyperuricemia group ( n = 254) had a higher prevalence of hypertension ( P = 0.013), diabetes mellitus ( P = 0.01), dyslipidemia ( P = 0.038), atrial fibrillation ( P = 0.001), and use of diuretics ( P < 0.001). Cardio-ankle vascular index (8.7 vs. 7.5, P < 0.001) and V̇e/V̇co2 slope (34.9 vs. 31.9, P = 0.02) were also higher. In addition, peak V̇o2 (14.9 vs. 17.9 ml·kg−1·min−1, P < 0.001) was lower. In the follow-up period (mean 897 days), cardiac and all-cause mortalities were significantly higher in those with hyperuricemia ( P = 0.006 and P = 0.004, respectively). In the multivariable Cox proportional hazard analyses after adjustment for several confounding factors including chronic kidney disease and use of diuretics, hyperuricemia was an independent predictor of all-cause mortality (hazard ratio 1.98, 95% confidence interval 1.036–3.793, P = 0.039). Hyperuricemia is associated with arterial stiffness, impaired exercise capacity, and high mortality in HFpEF.

scholarly journals Biomarkers and the prediction of adverse outcomes in patients with acute decompensated heart failure and kidney injury

2021 ◽  
Vol 10 (3) ◽  
pp. 65-71
Author(s):  
S. L. Glizer ◽  
O. A. Shtegman ◽  
M. M. Petrova
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Chronic Heart Failure ◽  
Adverse Outcome ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Adverse Outcomes ◽  
Global Burden ◽  
Modern Treatment

Abstract. Chronic heart failure is one of the main contributors to the Global Burden of Cardiovascular Diseases. Despite advances in modern treatment, acute decompensated heart failure (ADHF) incidence is high. Moreover, patients admitted for ADHF encounter renal impairment, which is another predictor of adverse outcome. There are number of biomarkers that allow clinicians to assess the prognosis of the disease in the early stages. The article presents an overview of contemporary biomarkers (utilizing multimarker approach), and identifies the most significant biological markers for evaluating ADHF and worsening renal function.

In-Hospital Serum Uric Acid Change Predicts Adverse Outcome in Patients With Heart Failure

2020 ◽  
Vol 26 (11) ◽  
pp. 968-976
Author(s):  
HIRONORI Yamamoto ◽  
YUJI NAGATOMO ◽  
KEITARO MAHARA ◽  
TSUTOMU YOSHIKAWA
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Adverse Outcome ◽  
Patients With Heart Failure

Prednisone lowers serum uric acid levels in patients with decompensated heart failure by increasing renal uric acid clearance

2016 ◽  
Vol 94 (7) ◽  
pp. 797-800 ◽  
Author(s):  
Chao Liu ◽  
Yuzhi Zhen ◽  
Qingzhen Zhao ◽  
Jian-Long Zhai ◽  
Kunshen Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Optimal Dose ◽  
Decompensated Heart Failure ◽  
High Dose ◽  
Acid Clearance ◽  
Uric Acid Clearance ◽  
Dose Prednisone ◽  
Medium Dose

Clinical studies have shown that large doses of prednisone could lower serum uric acid (SUA) in patients with decompensated heart failure (HF); however, the optimal dose of prednisone and underlying mechanisms are unknown. Thirty-eight patients with decompensated HF were randomized to receive standard HF care alone (n = 10) or with low-dose (15 mg/day, n = 8), medium-dose (30 mg/day, n = 10), or high-dose prednisone (60 mg/day, n = 10), for 10 days. At the end of the study, only high-dose prednisone significantly reduced SUA, whereas low- and medium-dose prednisone and standard HF care had no effect on SUA. The reduction in SUA in high-dose prednisone groups was associated with a significant increase in renal uric acid clearance. In conclusion, prednisone can reduce SUA levels by increasing renal uric acid clearance in patients with decompensated HF.

scholarly journals Prognostic impact of uric acid in patients with acute decompensated heart failure

2021 ◽  
Vol 93 (9) ◽  
pp. 1066-1072
Author(s):  
Svetlana N. Nasonova ◽  
Anastasiya E. Lapteva ◽  
Igor V. Zhirov ◽  
Dzambolat R. Mindzaev ◽  
Sergey N. Tereshchenko
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Acute Decompensated Heart Failure ◽  
Nyha Class ◽  
Decompensated Heart Failure ◽  
Prognostic Impact ◽  
Diuretic Resistance ◽  
End Point ◽  
Significant Difference ◽  
Moderate Negative Correlation

Aim. To evaluate the prognostic impact of serum uric acid (SUA) on clinical outcomes in patients with acute decompensated heart failure, as well as identify the correlation between hyperuricemia and renal function and diuretic resistance in these patients. Materials and methods. The study included 175 patients (125 men and 50 women) with NYHA class IIIV acute decompensated heart failure. Median age was 64 (5675) years. The Information regarding the survival was obtained 3 years after the admission by telephone calls. Results. 57 patients reached the end point (death from all causes); therefore, all patients were divided into groups: "alive", "dead". The SUA levels did not differ in the groups. The only significant difference in the studied parameters was the estimated glomerular filtration rate (eGFR), which was significantly higher in the "alive" group [70.5 (52.894) and 56 (4079), respectively; p=0.006]. A moderate negative correlation was found between SUA levels and eGFR in the correlation analysis (r=-0.313, p0.001). A comparative analysis showed, that SUA level on admission was significantly higher in patients who subsequently received increased doses of diuretics than in patients with a satisfactory response to standard doses of diuretics [567.8 (479.6791.9) and 512 (422.4619.4), respectively; p=0.011]. Also, higher eGFR level on admission was observed in patients from the normal SUA level group than in patients from the hyperuricemia group [94 (74.5101.5) and 63 (48.881.3), respectively; p=0.002]. Conclusion. We found no significant differences in the uric acid level in patients who reached the end point and those who did not reach it during the three-year follow-up. However, the found correlation between uric acid levels and diuretic resistance calls for further research.

Elevated D-dimer levels predict an adverse outcome in hospitalized patients with acute decompensated heart failure

2016 ◽  
Vol 204 ◽  
pp. 42-44 ◽  
Author(s):  
Yuichiro Minami ◽  
Shintaro Haruki ◽  
Kentaro Jujo ◽  
Ryosuke Itani ◽  
Kensuke Shimazaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Outcome ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Hospitalized Patients ◽  
D Dimer
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