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Review
. 2023 Jan 24;81(3):270-282.
doi: 10.1016/j.jacc.2022.10.028.

Albuminuria and Heart Failure: JACC State-of-the-Art Review

Muhammad Shahzeb Khan  1 , Izza Shahid  2 , Stefan D Anker  3 , Gregg C Fonarow  4 , Marat Fudim  5 , Michael E Hall  6 , Adrian Hernandez  5 , Alanna A Morris  7 , Tariq Shafi  8 , Matthew R Weir  9 , Faiez Zannad  10 , George L Bakris  11 , Javed Butler  12
Affiliations
Free article
Review

Albuminuria and Heart Failure: JACC State-of-the-Art Review

Muhammad Shahzeb Khan et al. J Am Coll Cardiol. .
Free article

Abstract

Although chronic kidney disease is characterized by low glomerular filtration rate (GFR) or albuminuria, estimated GFR (eGFR) is more widely utilized as a marker of risk profile in cardiovascular diseases, including heart failure (HF). The presence and magnitude of albuminuria confers a strong prognostic association in forecasting risk of incident HF as well as its progression, irrespective of eGFR. Despite the high prevalence of albuminuria in HF, whether it adds incremental prognostic information in clinical practice and serves as an independent risk marker, and whether there are any therapeutic implications of assessing albuminuria in patients with HF is less well-established. In this narrative review, we assess the potential role of albuminuria in risk profiling for development and progression of HF, strengths and limitations of utilizing albuminuria as a risk marker, its ability to serve in HF risk prediction models, and the implications of adopting albuminuria as an effective parameter in cardiovascular trials and practice.

Keywords: albuminuria; clinical trials; heart failure.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Anker has received grants from Vifor International and Abbott; and has received consulting fees from AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Novartis, Servier, Actimed, Bioventrix, Brahms, Cardiac Dimensions, Cardior, Cordio, CVRx, Impulse Dynamics, Edwards, Farraday, Occlutech, Respicardia, and V-Wave, all outside the submitted work. Dr Fonarow has received consulting fees from Abbott, Amgen, AstraZeneca, Bayer, CHF Solutions, Edwards, Janssen, Medtronic, Merck, and Novartis. Dr Fudim has received grants from the National Heart, Lung, and Blood Institute (NHLBI) (K23HL151744), the American Heart Association (20IPA35310955), Bayer, Bodyport, BTG Specialty Pharmaceuticals, and Verily; he receives consulting fees from Abbott, Alleviant, Audicor, AxonTherapies, Bayer, Bodyguide, Bodyport, Boston Scientific, Coridea, CVRx, Daxor, Deerfield Catalyst, Edwards LifeSciences, Feldschuh Foundation, Fire1, Gradient, Intershunt, Medtronic, NXT Biomedical, Pharmacosmos, PreHealth, Shifamed, Splendo, Vironix, Viscardia, and Zoll. Dr Hernandez has received consulting fees from AstraZeneca, Bayer, Boston Scientific, Merck, Novartis, and Sanofi; and has received research support from AstraZeneca, GlaxoSmithKline, Luitpold, Merck, and Novartis. Dr Morris has received research support from the National Heart, Lung, and Blood Institute, the Agency for Healthcare Research and Quality, the Woodruff Foundation, and the Association of Black Cardiologists; and has served as a consultant for Acorai, Boehringer Ingelheim Lilly, Cytokinetics, and Ionis. Dr Shafi has consultancy agreements with Siemens; has received research funding from Baxter (clinical trial); and has received honoraria from Cara Therapeutics, the National Institutes of Health, and Siemens. Dr Weir has been a scientific advisor for Janssen, AstraZeneca, NovoNordisk, Merck, Vifor, Boehringer Ingelheim, and Bayer. Dr Zannad has received consulting fees from Amgen, Applied Therapeutics, AstraZeneca, Bayer, Boehringer, Cardior, Cereno Scientific, Cellprothera, CEVA, CVRx, Merck, Novartis, Servier, and Vifor-Pharma; and has been a founder of CardioRenal and CVCT. Dr Bakris has been a consultant for Merck, Bayer, Vascular Dynamics, KBP Biosciences, Ionis, Alnylam, and AstraZeneca; and has received research support (steering committee of trials) from Bayer and Vascular Dynamics. Dr Butler has received consulting fees from BI, Cardior, CVRx, Foundry, G3 Pharma, Imbria, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, Sanofi, Sequana Medical, V-Wave Ltd., and Vifor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.