Albuminuria as a marker of systemic congestion in patients with heart failure

Eva M. Boorsma; Jozine M. Ter Maaten; Kevin Damman; Bart J. van Essen; Faiez Zannad; Dirk J. van Veldhuisen; Nilesh J. Samani; Kenneth Dickstein; Marco Metra; Gerasimos Filippatos; Chim C. Lang; Leong Ng; Stefan D. Anker; John G. Cleland; Pierpaolo Pellicori; Ron T. Gansevoort; Hiddo J. L. Heerspink; Adriaan A. Voors; Johanna E. Emmens

doi:10.1093/eurheartj/ehac528

Albuminuria as a marker of systemic congestion in patients with heart failure

Eva M. Boorsma, Jozine M. Ter Maaten, Kevin Damman, Bart J. van Essen, Faiez Zannad, Dirk J. van Veldhuisen, Nilesh J. Samani, Kenneth Dickstein, Marco Metra, Gerasimos Filippatos, Chim C. Lang, Leong Ng, Stefan D. Anker, John G. Cleland, Pierpaolo Pellicori, Ron T. Gansevoort, Hiddo J. L. Heerspink, Adriaan A. Voors (Lead / Corresponding author), Johanna E. Emmens

Molecular and Clinical Medicine

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Abstract

Aims: Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserved ejection fractions were evaluated.

Methods and results: Two thousand three hundred and fifteen patients included in the index cohort of BIOSTAT-CHF were evaluated and findings were validated in the independent BIOSTAT-CHF validation cohort (1431 patients). Micro-albuminuria and macro-albuminuria were defined as urinary albumin-creatinine ratio (UACR) >30 mg/gCr and >300 mg/gCr in spot urines, respectively. The prevalence of micro- and macro-albuminuria was 35.4% and 10.0%, respectively. Patients with albuminuria had more severe heart failure, as indicated by inclusion during admission, higher New York Heart Association functional class, more clinical signs and symptoms of congestion, and higher concentrations of biomarkers related to congestion, such as biologically active adrenomedullin, cancer antigen 125, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (all P < 0.001). The presence of albuminuria was associated with increased risk of mortality and heart failure (re)hospitalization in both cohorts. The strongest independent association with log UACR was found for log NT-proBNP (standardized regression coefficient 0.438, 95% confidence interval 0.35-0.53, P < 0.001). Hierarchical clustering analysis demonstrated that UACR clusters with markers of congestion and less with indices of renal function. The validation cohort yielded similar findings.

Conclusion: In patients with new-onset or worsening heart failure, albuminuria is consistently associated with clinical, echocardiographic, and circulating biomarkers of congestion.

Original language	English
Pages (from-to)	368-380
Number of pages	13
Journal	European Heart Journal
Volume	44
Issue number	5
Early online date	23 Sep 2022
DOIs	https://doi.org/10.1093/eurheartj/ehac528
Publication status	Published - 1 Feb 2023

Keywords

Albuminuria
Congestion
Cardiorenal interaction
Biomarkers
Central venous pressure

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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Boorsma, E. M., Ter Maaten, J. M., Damman, K., van Essen, B. J., Zannad, F., van Veldhuisen, D. J., Samani, N. J., Dickstein, K., Metra, M., Filippatos, G., Lang, C. C., Ng, L., Anker, S. D., Cleland, J. G., Pellicori, P., Gansevoort, R. T., Heerspink, H. J. L., Voors, A. A., & Emmens, J. E. (2023). Albuminuria as a marker of systemic congestion in patients with heart failure. European Heart Journal, 44(5), 368-380. https://doi.org/10.1093/eurheartj/ehac528

@article{e800c07c2b0546eaa8e673cf8a167cbd,

title = "Albuminuria as a marker of systemic congestion in patients with heart failure",

abstract = "Aims: Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserved ejection fractions were evaluated.Methods and results: Two thousand three hundred and fifteen patients included in the index cohort of BIOSTAT-CHF were evaluated and findings were validated in the independent BIOSTAT-CHF validation cohort (1431 patients). Micro-albuminuria and macro-albuminuria were defined as urinary albumin-creatinine ratio (UACR) >30 mg/gCr and >300 mg/gCr in spot urines, respectively. The prevalence of micro- and macro-albuminuria was 35.4% and 10.0%, respectively. Patients with albuminuria had more severe heart failure, as indicated by inclusion during admission, higher New York Heart Association functional class, more clinical signs and symptoms of congestion, and higher concentrations of biomarkers related to congestion, such as biologically active adrenomedullin, cancer antigen 125, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (all P < 0.001). The presence of albuminuria was associated with increased risk of mortality and heart failure (re)hospitalization in both cohorts. The strongest independent association with log UACR was found for log NT-proBNP (standardized regression coefficient 0.438, 95% confidence interval 0.35-0.53, P < 0.001). Hierarchical clustering analysis demonstrated that UACR clusters with markers of congestion and less with indices of renal function. The validation cohort yielded similar findings.Conclusion: In patients with new-onset or worsening heart failure, albuminuria is consistently associated with clinical, echocardiographic, and circulating biomarkers of congestion.",

keywords = "Albuminuria, Congestion, Cardiorenal interaction, Biomarkers, Central venous pressure",

author = "Boorsma, {Eva M.} and {Ter Maaten}, {Jozine M.} and Kevin Damman and {van Essen}, {Bart J.} and Faiez Zannad and {van Veldhuisen}, {Dirk J.} and Samani, {Nilesh J.} and Kenneth Dickstein and Marco Metra and Gerasimos Filippatos and Lang, {Chim C.} and Leong Ng and Anker, {Stefan D.} and Cleland, {John G.} and Pierpaolo Pellicori and Gansevoort, {Ron T.} and Heerspink, {Hiddo J. L.} and Voors, {Adriaan A.} and Emmens, {Johanna E.}",

note = "Copyright Information: {\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.",

year = "2023",

month = feb,

day = "1",

doi = "10.1093/eurheartj/ehac528",

language = "English",

volume = "44",

pages = "368--380",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "5",

}

Boorsma, EM, Ter Maaten, JM, Damman, K, van Essen, BJ, Zannad, F, van Veldhuisen, DJ, Samani, NJ, Dickstein, K, Metra, M, Filippatos, G, Lang, CC, Ng, L, Anker, SD, Cleland, JG, Pellicori, P, Gansevoort, RT, Heerspink, HJL, Voors, AA & Emmens, JE 2023, 'Albuminuria as a marker of systemic congestion in patients with heart failure', European Heart Journal, vol. 44, no. 5, pp. 368-380. https://doi.org/10.1093/eurheartj/ehac528

TY - JOUR

T1 - Albuminuria as a marker of systemic congestion in patients with heart failure

AU - Boorsma, Eva M.

AU - Ter Maaten, Jozine M.

AU - Damman, Kevin

AU - van Essen, Bart J.

AU - Zannad, Faiez

AU - van Veldhuisen, Dirk J.

AU - Samani, Nilesh J.

AU - Dickstein, Kenneth

AU - Metra, Marco

AU - Filippatos, Gerasimos

AU - Lang, Chim C.

AU - Ng, Leong

AU - Anker, Stefan D.

AU - Cleland, John G.

AU - Pellicori, Pierpaolo

AU - Gansevoort, Ron T.

AU - Heerspink, Hiddo J. L.

AU - Voors, Adriaan A.

AU - Emmens, Johanna E.

PY - 2023/2/1

Y1 - 2023/2/1

N2 - Aims: Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserved ejection fractions were evaluated.Methods and results: Two thousand three hundred and fifteen patients included in the index cohort of BIOSTAT-CHF were evaluated and findings were validated in the independent BIOSTAT-CHF validation cohort (1431 patients). Micro-albuminuria and macro-albuminuria were defined as urinary albumin-creatinine ratio (UACR) >30 mg/gCr and >300 mg/gCr in spot urines, respectively. The prevalence of micro- and macro-albuminuria was 35.4% and 10.0%, respectively. Patients with albuminuria had more severe heart failure, as indicated by inclusion during admission, higher New York Heart Association functional class, more clinical signs and symptoms of congestion, and higher concentrations of biomarkers related to congestion, such as biologically active adrenomedullin, cancer antigen 125, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (all P < 0.001). The presence of albuminuria was associated with increased risk of mortality and heart failure (re)hospitalization in both cohorts. The strongest independent association with log UACR was found for log NT-proBNP (standardized regression coefficient 0.438, 95% confidence interval 0.35-0.53, P < 0.001). Hierarchical clustering analysis demonstrated that UACR clusters with markers of congestion and less with indices of renal function. The validation cohort yielded similar findings.Conclusion: In patients with new-onset or worsening heart failure, albuminuria is consistently associated with clinical, echocardiographic, and circulating biomarkers of congestion.

AB - Aims: Albuminuria is common in patients with heart failure and associated with worse outcomes. The underlying pathophysiological mechanism of albuminuria in heart failure is still incompletely understood. The association of clinical characteristics and biomarker profile with albuminuria in patients with heart failure with both reduced and preserved ejection fractions were evaluated.Methods and results: Two thousand three hundred and fifteen patients included in the index cohort of BIOSTAT-CHF were evaluated and findings were validated in the independent BIOSTAT-CHF validation cohort (1431 patients). Micro-albuminuria and macro-albuminuria were defined as urinary albumin-creatinine ratio (UACR) >30 mg/gCr and >300 mg/gCr in spot urines, respectively. The prevalence of micro- and macro-albuminuria was 35.4% and 10.0%, respectively. Patients with albuminuria had more severe heart failure, as indicated by inclusion during admission, higher New York Heart Association functional class, more clinical signs and symptoms of congestion, and higher concentrations of biomarkers related to congestion, such as biologically active adrenomedullin, cancer antigen 125, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (all P < 0.001). The presence of albuminuria was associated with increased risk of mortality and heart failure (re)hospitalization in both cohorts. The strongest independent association with log UACR was found for log NT-proBNP (standardized regression coefficient 0.438, 95% confidence interval 0.35-0.53, P < 0.001). Hierarchical clustering analysis demonstrated that UACR clusters with markers of congestion and less with indices of renal function. The validation cohort yielded similar findings.Conclusion: In patients with new-onset or worsening heart failure, albuminuria is consistently associated with clinical, echocardiographic, and circulating biomarkers of congestion.

KW - Albuminuria

KW - Congestion

KW - Cardiorenal interaction

KW - Biomarkers

KW - Central venous pressure

U2 - 10.1093/eurheartj/ehac528

DO - 10.1093/eurheartj/ehac528

M3 - Article

C2 - 36148485

VL - 44

SP - 368

EP - 380

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 5

ER -

Albuminuria as a marker of systemic congestion in patients with heart failure

Abstract

Keywords

UN SDGs

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