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

https://doi.org/10.1016/j.jacc.2022.10.028Get rights and content
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Highlights

  • Albuminuria is prevalent in patients with heart failure and confers a strong, consistent and independent association with risk.

  • The causes of albuminuria in patients with heart failure are incompletely understood, as are the mechanisms linking it to disease progression and adverse outcomes.

  • Interventions that reduce albuminuria may potentially lower the risk of incident heart failure or prevent progression of existing heart failure.

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.

Key Words

albuminuria
clinical trials
heart failure

Abbreviations and Acronyms

CKD
chronic kidney disease
eGFR
estimated glomerular filtration rate
ESKD
end-stage kidney disease
GBM
glomerular basement membrane
HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
RAAS
renin-angiotensin-aldosterone system
T2DM
type 2 diabetes mellitus
UACR
urinary albumin-creatinine ratio

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Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

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