Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.727
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2015, vol. 24, nr 1, January-February, p. 47–54

doi: 10.17219/acem/38159

Publication type: original article

Language: English

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Hyperuricemia is an Independent Predictive Factor for Left Ventricular Diastolic Dysfunction in Patients with Chronic Kidney Disease

Leszek Gromadziński1,2,A,B,C,D,E,F, Beata Januszko-Giergielewicz2,B,E,F, Piotr Pruszczyk3,C,E,F

1 Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, Poland

2 Department of Internal Diseases, Gastroenterology, Cardiology and Infectiology, University of Warmia and Mazury in Olsztyn, Poland

3 Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland

Abstract

Background. It has been reported that elevated serum uric acid (UA) levels is an independent factor of poor prognosis in patients with chronic heart failure and chronic kidney disease (CKD).
Objectives. In our study, we assessed the potential impact of hyperuricemia on left ventricular (LV) diastolic dysfunction (DD) in patient with CKD.
Material and Methods. . The study group consisted of 50 patients with CKD, stages 2–5. Standard echocardiography and tissue Doppler imaging (TDI) were performed. The levels of UA and N-terminal prohormone brain natriuretic peptide (NT-proBNP) were determined. Patients were divided into two groups according to the results of peak mitral annular early diastolic velocity (EmLV): group with LV diastolic dysfunction (EmLV < 8 cm/s) DD (+) and group with normal LV diastolic function DD (–), when EmLV ≥ 8 cm/s.
Results. Patients DD (+) group, as compared to DD (–) patients were characterized by significantly higher serum UA levels [6.7 (4.4–14.3) mg/dL vs 5.8 (1.9–8.9) mg/dL, p = 0.004] respectively. The area under the receiver operating characteristic (ROC) curve was of serum UA levels for the detection of LV diastolic dysfunction was 0.734, 95% confidence interval (CI) 0.590–0.849, p = 0.001, whereas ROC derived UA value of > 6.0 mg/dL was characterized by a sensitivity of 76.9% and specificity of 62.5% for diagnosing LV diastolic dysfunction. The independent variable predicting LV diastolic dysfunction as measured by a multivariate logistic regression analysis was UA level > 6.0 mg/dL with odds ratio (OR) = 14.3 (95% CI 2.0–103.2), p = 0.006.
Conclusion. Hyperuricemia is an independent predictive factor for LV diastolic dysfunction in patients with CKD.

Key words

chronic kidney disease, hyperuricemia, left ventricular diastolic dysfunction, echocardiography.

References (21)

  1. Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, Tuttle KR, Rodriguez-Itube B, Herrera-Acosta J, Mazzali M: Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 2003, 41, 1183–1190.
  2. Nagahama K, Inoue T, Iseki K, Touma T, Kinjo K, Ohya Y, Takishita S: Hyperuricemia as a predictor of hypertension in a screened cohort in Okinawa, Japan. Hypertens Res 2004, 27, 835–841.
  3. Krishnan E: Hyperuricemia and incident heart failure. Circ Heart Fail 2009, 2, 556–562.
  4. Hamaguchi S, Furumoto T, Tsuchihash-Makaya M, Goto K, Goto D, Yokota T, Kinugawa S, Yokoshiki H, Takeshita A, Tsutsui H: JARE-CARD Investigators. Hyperuricemia predicts adverse outcomes in patients with heart failure. Int J Cardiol 2011, 151, 143–147.
  5. Wang S, Shu Z, Tao Q, Yu C, Zhan S, Li L: Uric acid and incident chronic kidney disease in a large health checkup population in Taiwan. Nephrology 2011, 16, 767–776.
  6. Bergamini C, Cicoira M, Rossi A, Vassanelli C: Oxidative stress and hyperuricaemia: pathophysiology, clinical relevance, and therapeutic implications in chronic heart failure. Eur J Heart Fail 2009, 11, 444–452.
  7. Small DM, Coombes JS, Bennett N, Johnson DW, Gobe GC: Oxidative stress, anti-oxidant therapies and chronic kidney disease. Nephrology 2012, 17, 311–321.
  8. Cicoira M, Zanolla L, Rossi A, Golia G, Franceschini L, Brighetti G, Zeni P, Zardini P: Elevated serum uric acid levels are associated with diastolic dysfunction in patients with dilated cardiomyopathy. Am Heart J 2002, 143, 1107–1111.
  9. Krishnan E, Hariri A, Dabbous O, Pandya BJ: Hyperuricemia and the echocardiographic measures of myocardial dysfunction. Congest Heart Fail 2012, 18, 138–143.
  10. National Kidney Foundation. K/DOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 2, Suppl. 1, 46–47.
  11. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ: Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations of chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, d
  12. Devereux RB, Alonso D, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N: Echocardiographic assessment of left ventricular hypertrophy, comparison to necropsy findings. Am J Cardiol 1986, 57, 450–455.
  13. Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C: Doppler echocardiographic measurement of low velocity motion of the left ventricular posterior wall. Am J Cardiol 1989, 64, 66–75.
  14. Garcia MJ, Thomas JD, Klein AL: New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 1998, 32, 865–875.
  15. Fröhlich M, Imhof A, Berg G, Hutchinson WL, Pepys MB, Boeing H, Muche R, Brenner H, Koenig W: Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care 2000, 23, 1835–1839.
  16. Ekundayo OJ, Dell’Italia LJ, Sanders PW, Arnett D, Aban I, Love TE, Filippatos G, Anker SD, Lioyd-Jones DM, Bakris G, Mujib M, Ahmed A: Association between hyperuricemia and incident heart failure among older adults: a propensity-matched study. Int J Cardiol 2010, 142, 279–287.
  17. Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, Davos CH, Cicoira M, Shamin W, Kemp M, Segal R, Osterziel KJ, Leyva F, Hetzer R, Ponikowski P, Coats AJ: Uric acid and survival in chronic heart failure: validation andapplication in metabolic, functional, and hemodynamic staging. Circulation 2003, 107, 1991–1997.
  18. Sakai H, Tsutamoto T, Tsutsui T, Tanaka T, Ishikawa C, Horie M: Serum level of uric acid, partly secreted from the failing heart, is a prognostic marker in patients with congestive heart failure. Circ J 2006, 70, 1006–1011.
  19. Njaman W, Iesaki T, Iwana Y, Takasaki Y, Daida H: Serum uric acid as a prognostic predictor in pulmonary arterial hypertension with connective tissue disease. Int Heart J 2007, 48, 523–532.
  20. Bendayan D, Shitrit D, Ygla M, Huerta M, Fink G, Kramer MR: Hyperuricemia as a prognostic factor in pulmonary arterial hypertension. Respir Med 2003, 97, 130–133.
  21. Khosla UM, Zharikov S, Finch JL, Nakagawa T, Roncal C, Mu W, Krotova K, Block ER, Prabhakar S, Johnson RJ: Hyperuricemia induces endothelial dysfunction. Kidney Int 2005, 67, 1739–1742.