Journal of cardiac failure · 2026
Implications of urinary albumin-to-creatinine ratio for subsequent kidney function decline and kidney-related outcomes in patients hospitalized for worsening heart failure: Insights from the JROADHF-NEXT registry.
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Akama Yuka, Singh Yu Suresvar, Nakade Taisuke, Fujimoto Yudai, Ide Tomomi, Kida Keisuke, Matsushima Shouji, Enzan Nobuyuki, Ikeda Masataka, Kitai Takeshi, Taniguchi Tatsunori, Okumura Takahiro, Tohyama Takeshi, Tsutsui Hiroyuki, Ninomiya Toshiharu, Minamino Tohru, Ter Maaten Jozine M, Damman Kevin, Voors Adriaan A, Matsue Yuya
Аннотация
BACKGROUND: Albuminuria is a well-established marker of kidney damage. However, its association with subsequent kidney function and outcomes in patients with heart failure remains unclear.
METHODS: We utilized data from JROADHF-NEXT, a prospective, nationwide registry enrolling patients hospitalized for heart failure. Urinary albumin-to-creatinine ratio (UACR) was measured at discharge, and patients were categorized as A1 (<30 mg/gCr), A2 (30-300 mg/gCr), or A3 (>300 mg/gCr). Outcomes of interest were 2-year all-cause mortality and a composite kidney-related endpoint including kidney-related death, initiation of maintenance dialysis, a ≥40% decline in estimated glomerular filtration rate (eGFR) at 1-year, or progression to kidney failure.
RESULTS: Among 3,107 patients, a total of 695 (22.4%) and 361 (11.6%) patients were categorized as A2 and A3, respectively. Higher UACR categories were associated with a greater decline in eGFR from discharge to 1 year (A1: -2.4±0.3; A2: -4.2±0.5; A3: -5.1±0.7 mL/min/1.73 m2, P < 0.001). The composite kidney-related endpoint occurred in 195 patients (6.3%), with higher risk in A2 (odds ratio [OR] 1.83; 95% confidence interval [CI] 1.27-2.61; P = 0.001) and A3 (OR 3.69; 95% CI 2.48-5.44; P < 0.001) compared to A1. Higher UACR categories were independently associated with increased mortality (A2 vs A1, Hazard ratio [HR] 1.37; 95% CI 1.12-1.67; P = 0.002; A3 vs A1, HR 1.45; 95% CI 1.12-1.87; P = 0.005).
CONCLUSIONS: Albuminuria measured at discharge was independently associated with subsequent kidney function decline, adverse kidney-related outcomes, and increased mortality.
METHODS: We utilized data from JROADHF-NEXT, a prospective, nationwide registry enrolling patients hospitalized for heart failure. Urinary albumin-to-creatinine ratio (UACR) was measured at discharge, and patients were categorized as A1 (<30 mg/gCr), A2 (30-300 mg/gCr), or A3 (>300 mg/gCr). Outcomes of interest were 2-year all-cause mortality and a composite kidney-related endpoint including kidney-related death, initiation of maintenance dialysis, a ≥40% decline in estimated glomerular filtration rate (eGFR) at 1-year, or progression to kidney failure.
RESULTS: Among 3,107 patients, a total of 695 (22.4%) and 361 (11.6%) patients were categorized as A2 and A3, respectively. Higher UACR categories were associated with a greater decline in eGFR from discharge to 1 year (A1: -2.4±0.3; A2: -4.2±0.5; A3: -5.1±0.7 mL/min/1.73 m2, P < 0.001). The composite kidney-related endpoint occurred in 195 patients (6.3%), with higher risk in A2 (odds ratio [OR] 1.83; 95% confidence interval [CI] 1.27-2.61; P = 0.001) and A3 (OR 3.69; 95% CI 2.48-5.44; P < 0.001) compared to A1. Higher UACR categories were independently associated with increased mortality (A2 vs A1, Hazard ratio [HR] 1.37; 95% CI 1.12-1.67; P = 0.002; A3 vs A1, HR 1.45; 95% CI 1.12-1.87; P = 0.005).
CONCLUSIONS: Albuminuria measured at discharge was independently associated with subsequent kidney function decline, adverse kidney-related outcomes, and increased mortality.