Abstract 12048: Subclinical Microalbuminuria is Associated With Poor Prognosis in Patients With Chronic Heart Failure With Preserved Renal Function-A Report From the CHART-2 Study-
Objectives: According to the latest classification of chronic kidney disease (CKD), microalbuminuria, defined as urinary albumin to creatinine ratio (UACR) ≥30mg/g, is a risk factor even in the patients with preserved glomerular filtration rate (GFR, ml/min/1.73m2). However, prognostic impacts of subclinical albuminuria (UACR≤30mg/g) are unclear in patients with chronic heart failure (CHF) with preserved or mildly reduced GFR.
Methods: After exclusion of patients with GFR≤30 ml/min/1.73m2 or those on hemodialysis, we enrolled 1,918 consecutive symptomatic CHF patients (mean age 67.1 years, 69.2% male) from our Chronic Heart Failure Analysis and Registry in the Tohoku District 2 Study (n=10,219). As the classification and regression tree (CART) analysis identified UACR of 10.2 mg/g as a discriminating point to stratify the risk for the composite of death, acute myocardial infarction, HF admission and stroke, we defined subclinical albuminuria as UACR of ≥10 and ≤30 mg/g.
Results: There were 439 composite endpoints (22.9%) during the median follow-up of 2.7 years. The patients with subclinical albuminuria were characterized by higher age and higher systolic blood pressure compared with those with UACR≤10. Kaplan-Meier and multivariate Cox regression models revealed that subclinical albuminuria was significantly associated with increased composite endpoints with hazard ratios of 2.00 (P≤0.001) and 1.93 (P≤0.001) in patients with preserved (>60 ml/min/1.73m2) or mildly reduced (30-59 ml/min/1.73m2) GFR, respectively (Figure): Furthermore, the prognostic impacts of subclinical and clinical albuminuria were almost comparable in the patients with mildly reduced GFR.
Conclusions: UACR of ≥10 and ≤30 mg/g was associated with increased risk of cardiovascular events in CHF patients with mildly reduced or preserved GFR. Thus, the presence of subclinical albuminuria should be examined to stratify the risk of CHF patients regardless of renal function.
- © 2013 by American Heart Association, Inc.