Prednisone may safely lower uric acid levels in patients with heart failure

Uric acid levels in patients with symptomatic heart failure and hyperuricemia were successfully lowered with prednisone treatment, and renal response to diuretics was improved, according to study findings.

Researchers studied 191 patients with symptomatic heart failure (HF) in the New York Heart Association Function Class III to IV and hyperuricemia, which was classified as a serum uric acid (SUA) level of greater than 7 mg/dL. Patients with active myocarditis taking xanthine oxidase inhibitors were excluded. Mean patient age was 52.1 years, and 149 of the patients were male.

Upon initiation of treatment, the median dose of prednisone administered was 50 mg per day. Urine output was recorded daily, and urine concentrations of SUA and serum creatinine (SCr) were recorded at baseline, at 5 to 7 days after treatment initiation (timepoint 1) and at 10 to 14 days after treatment initiation (timepoint 2).

Of the 191 patients, SUA was recorded in 165 patients at timepoint 1 and in 168 patients at timepoint 2.

Compared with baseline levels, prednisone treatment reduced SUA by 1.69 mg/dL at timepoint 1 and by 2.99 mg/dL at timepoint 2. Hematocrit increased, and fluid retention was not observed, according to the researchers.

Eight patients died within 30 days of the study initiation. Improved clinical status was seen in 172 patients, whereas seven patients deteriorated. Twenty-one of 165 patients had transient hypokalemia at timepoint 1, and 10 of 168 patients were reported to have transient hypokalemia at timepoint 2.

All patients with diabetes had severe hyperglycemia, which was resolved by adjusting the dose of insulin, according to the researchers. - by Shirley Pulawski

Disclosure: The study was supported by the Hebai Province Government (Hebei Provincial Major Medical Research Project ZD2013083).

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Source: Meng H, et al. J Rheumatol. 2015;doi:10.3899/jrheum.141037.