High Urinary Albumin Affects Death Risk for Heart Failure

Urinary albumin to creatinine ratio may offer prognostic guide to stratify risk for these patients

23 aug 2009-- An elevated urinary albumin to creatinine ratio (UACR) is a predictor of cardiovascular events and death in heart failure patients and may offer clinicians a prognostic guide for risk stratification, according to a study reported in the Aug. 15 issue of The Lancet.

Colette E. Jackson, of the University of Glasgow in the United Kingdom, and colleagues measured UACR at baseline and in follow-up for 2,310 heart failure patients. To determine if UACR had prognostic value, microalbuminuria and macroalbuminuria were correlated with the study's outcomes of death from any cause or a composite outcome including death from cardiovascular causes or hospitalization with worsening heart failure.

At study end point, the researchers found that 704 patients (30 percent) had microalbuminuria and 257 (11 percent) had macroalbuminuria, with both conditions increasing the risk of death and the composite outcome. For death, the adjusted hazard ratio was 1.62 for microalbuminuria versus normal albumin and 1.76 for macroalbuminuria versus normal albumin. For the composite outcome, the hazard ratio was 1.43 for microalbuminuria versus normal albumin and 1.75 for macroalbuminuria versus normal albumin.

"The prevalence of elevated UACR in patients with heart failure was high and was associated with a substantially increased risk of adverse clinical outcomes, including death. Even after adjustment for other risk factors in a multivariable model, microalbuminuria or macroalbuminuria remained strong independent predictors," the authors conclude.

Several of the study authors are employees of AstraZeneca or reported receiving research funding, lecture fees and consulting fees from the pharmaceutical firm, which funded the study.

Abstract
Full Text (subscription or payment may be required)