Russian Heart Failure Journal 2014year Prognostic role for fractional excretion of uric acid in patients with circulatory decompensation

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Prognostic role for fractional excretion of uric acid in patients with circulatory decompensation

Arutyunov A. G., Dragunov D. O., Arutyunov G. P., Rylova A. K., Sokolova A. V.
“Pirogov Russian National Research Medical University” MPH RF, Ostrovitianov 1, Moscow, Russia, 117997

Keywords: circulatory decompensation, diuretics, 
natriuresis, prognosis, mortality, CHF, uric acid excretion

DOI: 10.18087 / rhfj.2014.5.2015

Background. Methodological difficulties in studying natriuresis have resulted in introducing to clinical practice an alternative marker of low natriuresis, the fractional excretion of uric acid (FE UA). Aim. To study the prognostic role of natriuresis as evaluated by excretion of an alternative natriuresis marker, uric acid, in patients with decompensated CHF. Materials and methods. 127 patients with circulatory decompensation (CD) were enrolled. Four patient cohorts were formed: CD + pneumonia; CD + CKD, CD + cirrhosis; and CD + pneumonia + CKD. Patients were evaluated at admission and after 7 days of treatment. In addition to general clinical evaluation, 24‑h sodium excretion and FE UA were studied. FE UA levels lower than 12 % are known to correspond to the level of true natriuresis in individuals with non-diuretic forced natriuresis. Results. Analysis of median natriuresis at admission and at 7 days showed an increase in natriuresis values from 178±108 mmol / l to 236±126 mmol / l, which was not statistically significant (p=0.2); at the same time, FE UA significantly increased from 11±1.8 % to 15±1.9 % (p <0.001) for the same period. In the most prognostically unfavorable cohorts (CD + pneumonia + CKD and CD + cirrhosis), natriuresis evaluated by EF UA was mostly lower than 30 mmol / l per day as indicated by EF UA <12 %. Risk for rehospitalization was 61 % (OR, 1.71 [95 % CI, 1.26; 2.33]) for patients with EF UA <12 % and 32 % for patients with EF UA >12 %. EF UA was significantly lower in patients who died (<12 %) than in survived patients. Conclusion. The absence of changes in natriuresis determined by changes in EF UA is an independent marker for high risk of rehospitalization and fatal outcome.
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Arutyunov A. G., Dragunov D. O., Arutyunov G. P. et al. Prognostic role for fractional excretion of uric acid in patients with circulatory decompensation. Russian Heart Failure Journal. 2014;15 (5): 280–287

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