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Proteinuria, chronic kidney disease, and the effect of an angiotensin receptor blocker in addition to an
Inder S Anand1, Kalkidan Bishu, Thomas S Rector
1VA Medical Center, Cardiology 111-C, Minneapolis, Minn 55417, USA. anand001@umn.edu
Circulation
|October 7, 2009
Summary
Proteinuria in heart failure (HF) patients independently predicts worse outcomes, even with chronic kidney disease (CKD). Valsartan treatment showed benefits for HF patients with CKD, reducing adverse events without worsening renal function significantly.
Area of Science:
- Cardiology
- Nephrology
- Clinical Trials
Background:
- Chronic kidney disease (CKD) is a known risk factor for adverse outcomes in heart failure (HF).
- The independent prognostic value of proteinuria in HF patients remains unclear.
- Renin-angiotensin system inhibitors are underused in HF with renal dysfunction due to safety concerns.
Purpose of the Study:
- To investigate whether proteinuria provides additional prognostic information in heart failure patients.
- To assess the effectiveness and safety of valsartan in heart failure patients with and without chronic kidney disease.
Main Methods:
- Analysis of data from the Valsartan in Heart Failure Trial (Val-HeFT) involving 5010 patients.
- Subgroup analysis based on the presence of CKD (eGFR <60 mL/min/1.73 m²) and dipstick-positive proteinuria.
- Multivariable Cox regression models to evaluate the association of proteinuria with outcomes and interactions with CKD and valsartan treatment.
Main Results:
- 58% of patients had CKD, and 8% had dipstick-positive proteinuria at baseline.
- Dipstick-positive proteinuria was independently associated with increased mortality (HR 1.28) and first morbid events (HR 1.28).
- The prognostic impact of proteinuria was similar in patients with and without CKD.
- Valsartan demonstrated a similar reduction in estimated glomerular filtration rate (eGFR) in both CKD and non-CKD groups.
- Valsartan significantly reduced the risk of first morbid events in the subgroup with CKD (HR 0.86).
Conclusions:
- Dipstick-positive proteinuria is an independent predictor of worse outcomes in heart failure patients, irrespective of CKD status.
- Valsartan is safe regarding renal function in HF patients with CKD, with similar eGFR changes compared to placebo.
- Valsartan offers a significant survival benefit for first morbid events in heart failure patients with CKD.
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