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. 2024 May 15;17(6):sfae140.
doi: 10.1093/ckj/sfae140. eCollection 2024 Jun.

Congestion as a crucial factor determining albuminuria in patients with cardiorenal disease

Pau Llàcer  1   2 , Marta Cobo Marcos  3   4 , Rafael de la Espriella  5 , Jara Gayán Ordás  6 , Isabel Zegri  7 , Aleix Fort  8 , Adriana Rodríguez Chavarri  9 , Ana Méndez  10 , Zorba Blázquez  11 , Pedro Caravaca Pérez  12 , Jorge Rubio Gracia  13 , Cristina Fernández  1   2 , Alejandro Recio-Mayoral  14 , Antonia Pomares  7 , Jose Manuel García Pinilla  15 , Jorge Vazquez López-Ibor  3 , Almudena Castro  9 , Maria Jose Soler  16 , Jose Luis Górriz  17 , Ramón Bascompte Claret  6 , Paula Fluvià  8 , Luis Manzano  1   2 , Julio Núñez  4   5
Affiliations

Congestion as a crucial factor determining albuminuria in patients with cardiorenal disease

Pau Llàcer et al. Clin Kidney J. .

Abstract

Background: Albuminuria could potentially emerge as a novel marker of congestion in acute heart failure. However, the current evidence linking albuminuria and congestion in patients with congestive heart failure (CHF) remains somewhat scarce. This study aimed to evaluate the prevalence of albuminuria in a cohort of patients with CHF, identify the independent factors associated with albuminuria and analyse the correlation with different congestion parameters.

Methods: This is a subanalysis of the Spanish Cardiorenal Registry, in which we enrolled 864 outpatients with heart failure and a value of urinary albumin:creatinine ratio (UACR) at the first visit.

Results: The median age was 74 years, 549 (63.5%) were male and 438 (50.7%) had a reduced left ventricular ejection fraction. A total of 350 patients (40.5%) had albuminuria. Among these patients, 386 (33.1%) had a UACR of 30-300 mg/g and 64 (7.4%) had a UACR >300 mg/g. In order of importance, the independent variables associated with higher UACR were estimated glomerular filtration rate determined by the Chronic Kidney Disease Epidemiology Collaboration equation (R2 = 57.6%), systolic blood pressure (R2 = 21.1%), previous furosemide equivalent dose (FED; R2 = 7.5%), antigen carbohydrate 125 (CA125; R2 = 6.1%), diabetes mellitus (R2 = 5.6%) and oedema (R2 = 1.9%). The combined influence of oedema, elevated CA125 levels and the FED accounted for 15.5% of the model's variability.

Conclusions: In patients with chronic stable heart failure, the prevalence of albuminuria is high. The risk factors of albuminuria in this population are chronic kidney disease and hypertension. Congestion parameters are also associated with increased albuminuria.

Keywords: albuminuria; cardiorenal disease; congestion; congestive heart failure; predictors.

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Conflict of interest statement

M.J.S. and J.N. are members of the CKJ editorial board.

Figures

Figure 1:
Figure 1:
Predictors of UACR after multivariate analysis in order of importance assessed by the coefficient of determination (R2).
Figure 2:
Figure 2:
Relationship between eGFR (functional form) and UACR (logarithmic form) after multivariable analysis.
Figure 3:
Figure 3:
Relationship between SBP (functional form) and UACR (logarithmic form) after multivariable analysis.
Figure 4:
Figure 4:
Relationship between FED (functional form) and UACR (logarithmic form) after multivariable analysis.
Figure 5:
Figure 5:
Relationship between CA125 (functional form) and UACR (logarithmic form) after multivariable analysis.
Figure 6:
Figure 6:
Relationship between oedemas (functional form) and UACR (logarithmic form) after multivariable analysis.
Figure 7:
Figure 7:
Relationship between age (functional form) and UACR (logarithmic form) after multivariable analysis.
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