Abstract 11150: Albuminuria in Heart Failure is More Strongly Associated with Markers of Congestion Than Renal Dysfunction

Abstract

Aims: Albuminuria is common in patients with heart failure (HF) and associated with worse outcomes. It is unknown whether albuminuria only reflects renal dysfunction or whether it is related to the pathophysiology of HF. We therefore aimed to study the clinical characteristics and biomarkers associated with albuminuria in patients with new onset or worsening HF. Methods and Results: In the current analysis, we included 2315 patients from the index cohort of BIOSTAT-CHF who had a spot urinary sample available at baseline, and validated findings in 1431 patients from the independent BIOSTAT-CHF validation cohort.Micro-albuminuria and macro-albuminuria were defined as UACR >30 mg/gCr and >300 mg/gCr, respectively.In the index cohort 242 patients (10%) had macro- and 819 (35.4%) had micro-albuminuria. Patients with any albuminuria were more likely to be hospitalized, had a higher NYHA-class, more clinical signs of congestion and higher concentrations of biomarkers related to congestion, such as bio-ADM, CA-125 and NT pro-BNP. Moreover, they were more likely to have a history of diabetes mellitus (56.6% vs. 27.7% for macro-albuminuria vs. no albuminuria), hypertension and atrial fibrillation (all p<0.001). From multivariable linear regression the strongest predictor for log(UACR) was log NT pro-BNP (standardized B 0.41, 95% CI 0.32 - 0.50, p <0.001). This correlation was similar for all estimated glomerular filtration rates (p for interaction = 0.256). A dendrogram based on hierarchical clustering (Figure) demonstrates that UACR clusters with markers of congestion and HF disease severity and not with markers of renal (dys)function. The validation cohort yielded similar findings. Conclusion: In patients with HF, the presence of albuminuria was more strongly related to markers of congestion than markers of renal dysfunction. These data may suggest a direct relationship between congestion and albuminuria or a common underlying pathophysiological mechanism.