The public defence will be held as a video conference over Zoom.
The defence will follow regular procedure as far as possible, hence it will be open to the public and the audience can ask ex auditorio questions when invited to do so.
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Digital Trial Lecture - time and place
Adjudication committee
- First opponent: Professor Michael Fu, University of Gothenburg, Sweden
- Second opponent: Professor Bjørn Egil Vikse, University of Bergen, Norway
- Third member and chair of the evaluation committee: Professor Sigrun Halvorsen, Institute of Clinical Medicine, University of Oslo
Chair of defence
Professor Emeritus Frode Vartdal, Institute of Clinical Medicine, University of Oslo
Principal Supervisor
Chief Physician Bård Waldum-Grevbo, Oslo University Hospital
Summary
Heart failure (HF) and chronic kidney disease are closely related and coexistence of the two conditions is detrimental for patient’s prognosis. Still, the mechanisms of the interplay are not fully understood and the evidence of treatment of patients with concurrent heart and kidney dysfunction is scarce.
The aims of the thesis were to assess whether diabetes mellitus and elevated uric acid are independently associated with mortality of Norwegian HF outpatients and to explore if the effect was modified by reduced renal function and other factors. Furthermore, to investigate the effect of spironolactone on survival of HF outpatients with reduced renal function as its safety is uncertain due to risk of deteriorating renal function. Data from Norwegian Heart Failure Registry were accessed and propensity score matching was used to correct for confounding factors.
Initiation of spironolactone in HF patients with reduced renal function was associated with improved survival despite increased potassium levels and worsened renal function.
Diabetes was not found to be an independent predictor of all-cause mortality in HF outpatients and renal function did not modify the effect. However, the treatment of diabetic patients optimized at HF clinics comprised higher doses of HF medication than treatment of non- diabetics.
Uric acid in the highest quartile was found to be an independent predictor of all-cause mortality of HF outpatients. Importantly, the effect was gender-specific, with predictive value in women only but not in men. Renal function did not influence the relationship between high uric acid and survival of HF outpatients.
HF is complex syndrome and its treatment should be tailored to assure maximum effect and minimum adverse outcomes. Results from the present study may contribute to identify the subgroups of HF outpatients with special characteristics to personalize the treatment and maximize its benefit in order to improve the outcomes of these high risk patients.
Additional information
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