Associations of albuminuria in patients with chronic heart failure: findings in the ALiskiren Observation of heart Failure Treatment study

Eur J Heart Fail. 2011 Jul;13(7):746-54. doi: 10.1093/eurjhf/hfr031. Epub 2011 Apr 1.

Abstract

Aims: To examine the relationships between baseline characteristics and urinary albumin excretion in the extensively phenotyped patients in the ALiskiren Observation of heart Failure Treatment (ALOFT) study.

Methods and results: Urinary albumin creatinine ratio (UACR) was available in 190 of 302 (63%) patients randomized in ALOFT. Of these, 107 (56%) had normal albumin excretion, 63 (33%) microalbuminuria, and 20 (11%) macroalbuminuria. Compared with patients with normoalbuminuria, those with microalbuminuria had a greater prevalence of diabetes (48 vs. 26%, P = 0.005) and a lower estimated glomerular filtration rate (eGFR) (60.7 vs. 68.3 mL/min/1.73 m(2), P = 0.01). Patients with macroalbuminuria had additional differences from those with a normal UACR, including younger age (63 vs. 69 years, P = 0.02), higher glycated haemoglobin (HbA1c; 7.9 vs. 6.2%, P < 0.001), and different echocardiographic findings. Of the non-diabetic patients, 28% had microalbuminuria and 7% had macroalbuminuria. Independent predictors of UACR in these patients included N-terminal pro B-type natriuretic peptide (NT-proBNP), HbA1c, and left ventricular diastolic dimension. Increased UACR was not associated with markers of inflammation or of renin angiotensin aldosterone system activation and was not reduced by aliskiren.

Conclusions: Increased UACR is common in patients with heart failure, including non-diabetics. Urinary albumin creatinine ratio is independently associated with HbA1c and NT-proBNP, even in non-diabetic patients.

Trial registration: ClinicalTrials.gov NCT00219011.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albumins / metabolism*
  • Albuminuria / blood
  • Albuminuria / diagnosis*
  • Albuminuria / urine
  • Amides / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Confidence Intervals
  • Creatinine / blood*
  • Creatinine / metabolism
  • Creatinine / urine
  • Female
  • Fumarates / therapeutic use
  • Glycated Hemoglobin
  • Heart Failure / blood*
  • Heart Failure / diagnosis
  • Heart Failure / urine*
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Phenotype
  • Prognosis
  • Statistics as Topic
  • Stroke Volume
  • Surveys and Questionnaires
  • Ventricular Function, Left

Substances

  • Albumins
  • Amides
  • Antihypertensive Agents
  • Fumarates
  • Glycated Hemoglobin A
  • aliskiren
  • Creatinine

Associated data

  • ClinicalTrials.gov/NCT00219011