Prevalence and Prognostic Value of Elevated Urinary Albumin Excretion in Patients With Chronic Heart Failure

Abstract

on behalf of the GISSI-HF InvestigatorsBackground-Increased urinary excretion of albumin is an early sign of kidney damage and a risk factor for progressive cardiovascular and renal diseases and heart failure. There is, however, only limited information on the prevalence and prognostic role of urinary albumin excretion in patients with established chronic heart failure. Methods and Results-A total of 2131 patients enrolled in 76 sites participating in the GISSI-Heart Failure trial provided a first morning spot sample of urine at any of the clinical visits scheduled in the trial to calculate the urinary albumin-to-creatinine ratio. The relation between log-transformed urinary albumin-to-creatinine ratio and all-cause mortality (428 deaths, time from urine collection to event or censoring) was evaluated with Cox multivariable models adjusted for all significant risk factors at the time of urine collection, in the study population, and in patients without diabetes or hypertension. Almost 75% of the patients had normal urinary albumin excretion, but 19.9% had microalbuminuria (30 to 299 mg/g creatinine) and 5.4% had overt albuminuria (Ն300 mg/g). There was a progressive, significant increase in the adjusted rate of mortality in the study population (hazard ratio, 1.12; 95% CI, 1.05 to 1.18 per 1-U increase of log(urinary albumin-to-creatinine ratio), Pϭ0.0002) and in the subgroup of patients without diabetes or hypertension. Randomized treatments (n-3 polyunsaturated fatty acids or rosuvastatin) had no major impact on albumin excretion. Conclusions-Independently of diabetes, hypertension, or renal function, elevated albumin excretion is a powerful prognostic marker in patients with chronic heart failure. (Circ Heart Fail. 2010;3:65-72.)

Acute Kidney Injury Predicts Major Adverse Outcomes in Diabetes: Synergic Impact With Low Glomerular Filtration Rate and Albuminuria

“…In patients from the Atherosclerosis Risk in Communities (ARIC) study, cystatin C levels and elevated albuminuria were associated with a further risk of cardiovascular events, including heart failure (21). Interestingly, albuminuria was frequently observed and was a predictor of death in patients with heart failure in the GISSI-Heart Failure study (22). Our results indicate that all three renal markers have prognostic value in diabetes: AKI can be used alone During follow-up, the following major events were noted: hospitalization for heart failure (n = 157), myocardial infarction (n = 81), stroke (n = 55), lower-limb amputation (n = 54), lower-limb revascularization (n = 60), coronary artery revascularization (n = 101), carotid artery revascularization (n = 25), and renal failure (i.e., sustained doubling of serum creatinine or ESRD) (n = 79).…”

Prevalence, predictors and prognostic significance of microalbuminuria in acute cardiac patients: a single center experience

“…In chronic heart failure, elevated albumin excretion is a powerful prognostic marker for allcause mortality, independent of diabetes, hypertension, or renal function [19].…”

The prevalence of renal dysfunction and its influence on the prognosis of patients with acute heart failure

“…(2013), МАУ встречалась у 69 % пациентов, госпитализированных в связи с ОСН, и уровень МАУ коррелирует со значениями NT-proBNP [21]. Уровень МАУ является прогностическим фактором у пациентов с ХСН [22,23] [24]. Прогностическое же зна-чение МАУ у пациентов с ОСН в настоящее время менее изучено.…”