Prednisone for Heart Failure Patients With Hyperuricemia

Hyperuricemia in heart failure (HF) is linked to renal impairment, hemodynamic compromise, and inflammation. Hyperuricemic HF patients are characterized by worsening of renal function and fragile volume state, both of which restrict the use of non-steroidal anti-inflammatory drugs (NSAIDs) when treating concurrent inflammatory diseases. Recent small studies suggest that steroidal anti-inflammatory drug, prednisone, may have renal protective, UA lowering, and potentiating diuretic effects in hyperuricemic HF patients. However, general acceptance of prednisone as a treatment option for anti-inflammation therapy in patients with hyperuricemic HF requires more safety data. We therefore designed a randomized study to compare the safety and renal protective effects of short-term use of prednisone with allopurinol, a widely used xanthine oxidase inhibitor with a well-established safety profile in HF, in hyperuricemic HF patients.

Inclusion criteria

• chronic congestive heart failure
• 18-80 years old
• NYHA Class II-IV
• Serum uric acid > 7mg/dl
• left ventricular ejection fraction ≤ 45%

Exclusion criteria

• Acute gouty arthritis;
• Any condition (other than heart failure) that could limit the use of prednisone or xanthine oxidase inhibitors;
• Acute decompensated heart failure;
• Any concurrent disease that likely limits life expectancy;
• Active myocarditis, or an hypertrophic obstructive or restrictive cardiomyopathy;
• Myocardial infarction, stroke, unstable angina, or cardiac surgery within the previous 3 months;
• Indication for hemodialysis
• Creatinine> 3.0 mg per deciliter at admission to the hospital
• Uncontrolled systolic blood pressure > 140 mmHg
• Known bilateral renal artery stenosis
• Complex congenital heart disease
• Any signs of infections
• Enrollment in another clinical trial involving medical or device-based interventions