Congestion as a crucial factor determining albuminuria in in patients with cardiorenal disease
Pau Llàcer, Marta Cobo Marcos, Rafael de la Espriella, Jara Gayán Ordás, Isabel Zegri, Aleix Fort, Adriana Rodríguez Chavarri, Ana Méndez, Zorba Blázquez, Pedro Caravaca Pérez, Jorge Rubio Gracia, Cristina Fernández, Alejandro Recio-Mayoral, Antonia Pomares, Jose Manuel García Pinilla, Jorge Vazquez López-Ibor, Almudena Castro, Maria Jose Soler, Jose Luis Górriz, Ramón Bascompte Claret, Paula Fluvià, Luis Manzano, Julio NúñezAbstract
Background
Albuminuria could potentially emerge as a novel marker of congestion in acute heart failure. However, the current evidence linking albuminuria and congestion in patients with chronic heart failure (CHF) remains somewhat scarce. This study aimed to evaluate 1) the prevalence of albuminuria in a cohort of patients with CHF, 2) identify the independent factors associated with albuminuria, and 3) to analyze the correlation with different congestion parameters.
Methods and Results
This is a sub-analysis of the Spanish Cardiorenal Registry, in we which enrolled 864 outpatients with heart failure and a value of urinary albumin-to-creatinine ratio (UACR) at the first visit. The median age was 74 years, 549 (63.5%) were male, and 438 (50.7%) had a reduced left ventricular ejection fraction. A total of 350 patients (40.5%) had albuminuria. Among these patients, 386 (33.1%) had a UACR between 30 and 300 mg/g, while 64 (7.4%) had a UACR greater than 300 mg/g. In order of importance the independent variables associated with higher UACR were in Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), (R2: 57.6%), systolic blood pressure (SBP) (R2: 21.1%), previous furosemide equivalent dose (R2: 7.5%), antigen carbohydrate 125 (CA125) (R2: 6.1%), diabetes mellitus (R2: 5.6%) and edemas (R2: 1.9%). The combined influence of edema, elevated CA125 levels, and the furosemide equivalent dose accounted for 15.5% of the model's variability.
Conclusions
In patients with chronic stable heart failure, the prevalence of albuminuria is high. The risk factors of albuminuria in this population are chronic kidney disease and hypertension. Congestion parameters are also associated with increased albuminuria.