Albuminuria as a marker of systemic congestion in patients with heart failure.

Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserved ejection fractions were evaluated. Two thousand three hundred and fifteen patients included in the index cohort of BIOSTAT-CHF were evaluated and findings were validated in the independent BIOSTAT-CHF validation cohort (1431 patients). Micro-albuminuria and macro-albuminuria were defined as urinary albumincreatinine ratio (UACR) 30 mg/gCr and 300 mg/gCr in spot urines, respectively. The prevalence of micro- and macro-albuminuria was 35.4 and 10.0, respectively. Patients with albuminuria had more severe heart failure, as indicated by inclusion during admission, higher New York Heart Association functional class, more clinical signs and symptoms of congestion, and higher concentrations of biomarkers related to congestion, such as biologically active adrenomedullin, cancer antigen 125, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (all P 0.001). The presence of albuminuria was associated with increased risk of mortality and heart failure (re)hospitalization in both cohorts. The strongest independent association with log UACR was found for log NT-proBNP (standardized regression coefficient 0.438, 95 confidence interval 0.350.53, P 0.001). Hierarchical clustering analysis demonstrated that UACR clusters with markers of congestion and less with indices of renal function. The validation cohort yielded similar findings. In patients with new-onset or worsening heart failure, albuminuria is consistently associated with clinical, echocardiographic, and circulating biomarkers of congestion.

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The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.

Déclaration de conflit d'intérêts

Conflict of interest: K.D.: Consultancy fees Abbott, Boehringer Ingelheim, AstraZeneca; F.Z.: for Actelion, Amgen, Applied Theraputics, AstraZeneca, Bayer, Boehringer, Boston Scientific, Cardior, Cellprothera, Cereno, CEVA, CVRx, G3Pharmaceutical, Merck, Novartis, NovoNordisk, Vifor-Fresenius. Founder of CardioRenal and CVCT; M.M.: personal fees of minimal amounts in the last 3 years: from Actelion as member of Data Monitoring Committeee of sponsored clinical trials; from Amgen, Livanova, Servier, and Vifor pharma as member of Executive Committees of sponsored clinical trials; from AstraZeneca, Abbott vascular, Bayer, Boheringer Ingelhelm, and Edwards Therapeutics for participation to advisory boards and/or speeches at sponsored meetings; S.D.A.: fees from Abbott, Actimed, Bayer, Boehringer Ingelheim, Cardiac Dimension, Cordio, Impulse Dynamics, Novartis, Occlutech, Servier, and Vifor Pharma, and grant support from Abbott and Vifor Pharma.