Albuminuria is associated with worse outcomes in non-diabetics hospitalized with acute heart failure

Abstract Introduction Chronic kidney disease (CKD) is associated with an increased risk of mortality and heart failure (HF) hospitalization in patients with HF. Guidelines recommend measuring albuminuria, as the urinary albumin-to-creatinine ratio (UACR), to assess for CKD. The presence and severity of albuminuria are strongly associated with risk of developing HF and worse outcomes in individuals with chronic HF (CHF); however, the relationship between albuminuria and the prognosis of acute HF (AHF) is still unclear. We evaluated if the presence of albuminuria, systematically measured in ROSE-AHF trial (Renal Optimization Strategies Evaluation-Acute Heart Failure), and its change during hospitalization were associated with adverse outcomes in AHF. Methods In ROSE-AHF trial, 339 participants had baseline UACR measurements while 248 had measurements at Day 7 and 237 participants had UACR measurements at Day 7 and baseline for calculating change in UACR. The primary outcome was all-cause mortality at 6 months. The secondary outcome was a composite outcome of first HF hospitalization or cardiovascular mortality within 2 months. We evaluated the association of UACR with outcomes using Cox proportional hazards models. Because diabetes can cause albuminuria from different pathologic processes that may have different implications in this population, we tested for effect modification by diabetes status in all analyses by either testing the interaction between continuous UACR*diabetes status, or by performing analysis in subgroups of individuals with and without diabetes. Results During a median follow up of 177 days, 65 participants died. During a median 59 days of follow-up, 82 participants experienced the composite cardiovascular outcome. Baseline UACR was not associated with risk of all-cause mortality; however, there was a significant interaction by diabetes status (p-interaction 0.022) such that UACR was associated with mortality in non-diabetics but not in individuals with diabetes. Compared to the first tertile of UACR, non-diabetics in the third tertile of UACR had significantly higher risk of death (HR, 2.58; 95%CI, 1.00-6.66). Day 7 UACR and UACR change were not associated with risk of all-cause mortality and there was no significant interaction by diabetes status. Baseline and day7 UACR and UACR change were not associated with risk of composite outcome and no significant interaction by diabetes status was found. Conclusions In this study on AHF, albuminuria was not significantly associated with all-cause mortality, HF hospitalization, or cardiovascular mortality. However, our findings indicate that this relationship is highly dependent on diabetes status, as baseline albuminuria in non-diabetic patients was significantly associated with all-cause mortality.Table 1 Figure 1