Albuminuria in Heart Failure: A Cardiorenal Integration Biomarker Beyond Chronic Kidney Disease

While traditionally albuminuria has been considered a marker of glomerular injury and chronic kidney disease, recent evidence establishes it as a cardiorenal integration biomarker; a signal of systemic congestion, endothelial activation, and inadequate therapeutic control that may help identify patients who could benefit from intensive cardiorenal protective therapy, pending prospective validation. Initial management usually targets the achievement of euvolemia to address the albumin leakage caused by the increase in intraglomerular pressure due to increased central and renal venous pressures. Further management focuses on renin-angiotensin-aldosterone system inhibition and sodium-glucose cotransporter 2 inhibitors for the restoration of tubuloglomerular feedback and reduction of intraglomerular pressure. Urinary albumin is a readily accessible biomarker that enhances risk stratification and may guide the optimization of cardiorenal protective therapies in heart failure patients. Integration of routine urinary albumin-to-creatinine ratio monitoring into heart failure management is a promising frontier that requires validation.