To access this material please log in or register

Register Authorize

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.
  1. Lee DS, Austin PC, Rouleau JL et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003 Nov 19;290 (19):2581–7.
  2. O’Connor CM, Miller AB, Blair JE et al. Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction: results from efficasy of vasopressin antagonism in heart failure outcome study with tolvaptan (EVEREST) program. Am Heart J. 2010 May;159 (5):841–9.
  3. Maggioni AP, Dahlström U, Filippatos G et al. EURObservational Research Programme: regional differences and 1‑year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail. 2013;15 (7):808–17.
  4. Арутюнов Г. П., Оганезова Л. Г., Драгунов Д. О., Соколова А. В. Эпидемиология артериальной гипертензии: ее взаимосвязь с поражением почек и феноменом соль-чувствительности. Клиническая нефрология. 2013;2:67–72.
  5. Арутюнов Г. П., Драгунов Д. О., Соколова А. В. Взаимосвязь между натриийурезом, показателями центральной гемодинамики и плазменной концентрацией ангиотензинаII. Клиническая нефрология. 2013;6:24–8.
  6. Арутюнов Г. П., Драгунов Д. О., Соколова А. В. Оценка влияния петлевых диуретиков с разными периодами полувыведения на ретенцию натрия. Клиническая нефрология. 2013;5:8–12.
  7. Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. J Am Soc Nephrol. 2006 Jan;17 (1):17–25.
  8. Müller GA, Rodemann HP. Characterization of human renal fibroblasts in health and disease: I. Immunophenotyping of cultured tubular epithelial cells and fibroblasts derived from kidneys with histologically proven interstitial fibrosis. Am J Kidney Dis. 1991 Jun;17 (6):680–3.
  9. Mattana J, Singhal PC. Applied pressure modulates mesangial cell proliferation and matrix synthesis. Am J Hypertens. 1995 Nov;8 (11):1112–20.
  10. Verbalis JG. Disorders of body water homeostasis. Best Pract Res Clin Endocrinol Metab. 2003 Dec;17 (4):471–503.
  11. Beck LH. Hypouricemia in the syndrome of inappropriate secretion of antidiuretic hormone. N Engl J Med. 1979 Sep 6;301 (10):528–30.
  12. Spasovski G, Vanholder R, Allolio B et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014 Apr;29 (Suppl 2):i1‑i39.
  13. Imbriano LJ, Ilamathi E, Ali NM et al. Normal fractional urate excretion identifies hyponatremic patients with reset osmostat. J Nephrol. 2012 Sep;25 (5):833–8.
  14. Fenske W, Stork S, Koschker AC et al. Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metabol. 2008 Aug;93 (8):2991–7.
  15. Арутюнов А. Г., Рылова А. К., Арутюнов Г. П. Регистр госпитализированных пациентов с декомпенсацией кровообращения (Павловский регистр). Сообщение 1. Современная клиническая характеристика пациента с декомпенсацией кровообращения. Клинические фенотипы пациентов. Журнал Сердечная недостаточность. 2014;15 (1):23–32.
  16. Pépin M-N, Bouchard J, Legault L, Ethier J. Diagnostic Performance of Fractional Excretion of Urea and Fractional Excretion of Sodium in the Evaluations of Patients With Acute Kidney Injury With or Without Diuretic Treatment. Am J Kid Dis. 2007 Oct;50 (4):566–73.
  17. Kaplan AA, Kohn OF. Fractional excretion of urea as a guide to renal dysfunction. Am J Nephrol. 1992;12 (1-2):49–54.
  18. Carvounis CP, Nisar S, Guro-Razuman S. Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int. 2002 Dec;62 (6):2223–9.
  19. Физиология человека. В 3‑х томах. Под ред. Р. Шмидта и Г. Тевса. Пер. с англ. – 3‑е изд. – М.: Мир, 2005; Т.3 – с.788–798.
  20. Quiroz Y, Johnson RJ, Rodríguez-Iturbe B. The role of T cells in the pathogenesis of primary hypertension published online ahead of print. Nephrol Dial Transplant. 2012 Dec;27 (Suppl 4):2–5.
  21. Saeed M, Lim V, Malik A et al. Serial Measures of the Fractional Excretion of Urea (FEurea), Fractional Excretion of Sodium (FEna) and the Urea / Creatinine Ratio (UCr) for Predicting Changes in Renal Function in Ambulatory Heart Failure Patients. Canadian J Cardiol. 2012;28 (5):279.
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

To access this material please log in or register

Register Authorize
Ru En