Implications of urinary albumin-to-creatinine ratio for subsequent kidney function decline and kidney-related outcomes in patients hospitalized for worsening heart failure: Insights from the JROADHF-NEXT registry.

Background

Albuminuria is a well-established marker of kidney damage. However, its association with subsequent kidney function and outcomes in patients with heart failure remains unclear.

Methods

We utilized data from JROADHF-NEXT, a prospective, nationwide registry enrolling patients hospitalized for heart failure. Urinary albumin-to-creatinine ratio (UACR) was measured at discharge, and patients were categorized as A1 (<30 mg/gCr), A2 (30-300 mg/gCr), or A3 (>300 mg/gCr). Outcomes of interest were 2-year all-cause mortality and a composite kidney-related endpoint including kidney-related death, initiation of maintenance dialysis, a ≥40% decline in estimated glomerular filtration rate (eGFR) at 1-year, or progression to kidney failure.

Results

Among 3,107 patients, a total of 695 (22.4%) and 361 (11.6%) patients were categorized as A2 and A3, respectively. Higher UACR categories were associated with a greater decline in eGFR from discharge to 1 year (A1: -2.4±0.3; A2: -4.2±0.5; A3: -5.1±0.7 mL/min/1.73 m2, P < 0.001). The composite kidney-related endpoint occurred in 195 patients (6.3%), with higher risk in A2 (odds ratio [OR] 1.83; 95% confidence interval [CI] 1.27-2.61; P = 0.001) and A3 (OR 3.69; 95% CI 2.48-5.44; P < 0.001) compared to A1. Higher UACR categories were independently associated with increased mortality (A2 vs A1, Hazard ratio [HR] 1.37; 95% CI 1.12-1.67; P = 0.002; A3 vs A1, HR 1.45; 95% CI 1.12-1.87; P = 0.005).

Conclusions

Albuminuria measured at discharge was independently associated with subsequent kidney function decline, adverse kidney-related outcomes, and increased mortality.