Abstract

AIMS: Chronic kidney disease (CKD) increases the risk of morbidity and mortality in patients with heart failure (HF). Guidelines recommend assessing CKD using the urinary albumin-to-creatinine ratio (UACR), as albuminuria is strongly associated with the risk of incident HF and outcomes in chronic HF; however, its prognostic role in acute HF (AHF) remains unclear. We evaluated if albuminuria was associated with adverse outcomes in individuals hospitalized with AHF in Renal Optimization Strategies Evaluation-Acute Heart Failure (ROSE-AHF). METHODS: There were 339 participants with baseline UACR, 248 with UACR at Day 7 and 237 with both measurements for assessing change in UACR. Associations of baseline, Day 7 and change in UACR with all-cause mortality at 6 months and the composite of first HF hospitalization or cardiovascular mortality at 2 months were assessed with Cox proportional hazards models. We assessed for effect modification by treatment arm and diabetes status. RESULTS: The mean age was 70 years, 73.2% were male, 55.8% had diabetes mellitus, the mean estimated glomerular filtration rate was 45 mL/min/1.73 m² and mean UACR was 208 mg/g. There were 65 deaths and 82 HF hospitalizations or cardiovascular deaths. Baseline UACR was not associated with either outcome; however, there was a significant interaction by diabetes status for all-cause mortality (P = 0.022) such that baseline UACR was associated with the risk of death in non-diabetics [hazard ratio (HR) 2.58, 95% CI 1.00, 6.66, P = 0.050 third tertile versus first tertile], but not diabetics. Neither Day 7 UACR nor the change in UACR were associated with outcomes. CONCLUSIONS: Albuminuria is largely not associated with the risk of death, cardiovascular death, or HF hospitalization in AHF, except admission UACR is associated with the risk of death in non-diabetics.