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High-normal albuminuria and risk of heart failure in the community

Saul Blecker1, Kunihiro Matsushita, Anna Köttgen

  • 1Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. sblecker@jhmi.edu

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|May 10, 2011
PubMed

Insights

Albuminuria, even at high-normal levels, significantly increases heart failure risk. This association persists even in individuals with few cardiovascular risk factors, suggesting broader implications beyond kidney or heart disease.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Epidemiology

Background:

  • Albuminuria is a known cardiovascular risk factor.
  • The association between high-normal albuminuria and heart failure risk is not well-established.

Purpose of the Study:

  • To investigate the relationship between urinary albumin-creatinine ratio (UACR) and incident heart failure.
  • To determine if high-normal UACR levels predict heart failure risk.

Main Methods:

  • Prospective observational study of 10,975 participants from the Atherosclerosis Risk in Communities (ARIC) Study.
  • Urinary albumin-creatinine ratio (UACR) categorized into optimal, intermediate-normal, high-normal, microalbuminuria, and macroalbuminuria.
  • Incident heart failure defined as hospitalization or death; Cox proportional hazard models used for analysis, adjusting for cardiovascular risk factors and estimated glomerular filtration rate (eGFR).

Main Results:

  • Follow-up median of 8.3 years with 344 heart failure events.
  • Progressively increased heart failure risk observed with increasing UACR categories compared to normal UACR.
  • Adjusted Hazard Ratios (HR) for heart failure ranged from 1.54 (intermediate-normal) to 3.47 (macroalbuminuria).

Conclusions:

  • Albuminuria is associated with subsequent heart failure, even within the normal UACR range.
  • The findings suggest that the link between albuminuria and heart failure may involve mechanisms beyond ischemic heart disease or kidney disease (eGFR).
  • UACR measurement from a single random sample may be sufficient for risk assessment.
Abstract

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