Abstract
Background It has been reported that renal dysfunction has strong association with clinical outcomes in chronic heart failure (CHF) patients. Recent study demonstrated that several urinary markers were related to cardiac prognosis in CHF patients. Urinary μ 2 -microglobulin-creatinine ratio (UBCR) is a marker for renal tubular damage (RTD) and related to rapid deterioration of renal function. However, association between UBCR and cardiac prognosis has been not studied. The purpose of the present study was to examine whether: (1) UBCR is correlated with severity of heart failure; and (2) UBCR can predict clinical outcomes in CHF patients. Methods and Results We measured UBCR, urinary microalbumin-creatinine ratio, N-acetyl-beta-D-glucosamidase and estimated glomerular filtration rate (eGFR) in 193 CHF patients. Patients were prospectively followed during a median follow up period of 353 days. There were 46 cardiac events, including 10 cardiac deaths and 36 re-hospitalizations for worsening heart failure. Levels of UBCR increased with advancing NYHA functional class. Patients with cardiac events had higher levels of UBCR than those without. In the univariate Cox proportional hazard analysis, age, NYHA functional class, brain natriuretic peptide, eGFR and UBCR were independent risk factor for cardiac events. A multivariate Cox proportional hazard analysis revealed that UBCR is an independent predictor of cardiac events in CHF patients. We defined RTD as UBCR > 300 μg/g according to our previous report. Kaplan-Meier analysis demonstrated that cardiac event rate was higher in patients with RTD than in those without. In addition, Kaplan-Meier analysis demonstrated that RTD could strictly classify the prognosis of CHF patients without chronic kidney disease. Conclusion UBCR was related to the severity of heart failure and associated with high risk in CHF patients. RTD, as implicated by UBCR, could add clinical information about cardiac prognosis in CHF patients.
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