title: Prognostic impact of subclinical microalbuminuria in patients with chronic heart failure.
abstract: BACKGROUND
  Microalbuminuria, traditionally defined as urinary albumin/creatinine ratio (UACR) ≥30 mg/g, is a risk factor for mortality even in patients with preserved glomerular filtration rate (GFR). The prognostic impact of subclinical microalbuminuria, however, remains unknown in patients with chronic heart failure (CHF). METHODS AND RESULTS: In the Chronic Heart Failure Analysis and Registry in the Tohoku District 2 Study, we enrolled 2,039 consecutive symptomatic CHF patients (median age, 67.4 years; 68.9% male) after excluding those on hemodialysis. On classification and regression tree analysis, UACR=10.2 mg/g and 27.4 mg/g were identified as the first and second discriminating points to stratify the risk for composite of death, acute myocardial infarction, HF admission and stroke, therefore subclinical microalbuminuria was defined as UACR ≥10.2 and <27.4 mg/g. There were 506 composite endpoints (24.8%) during the median follow-up of 2.69 years. On Kaplan-Meier analysis and multivariate Cox modeling, subclinical microalbuminuria was significantly associated with increased composite endpoints with hazard ratios of 1.90 (P<0.001) and 2.29 (P<0.001) in patients with preserved (>60 ml·min(-1)·1.73 m(-2), n=1,129) or mildly reduced eGFR (30-59.9 ml·min(-1)·1.73 m(-2), n=789), respectively. In patients with severely reduced GFR (eGFR <30 ml·min(-1)·1.73 m(-2), n=121), >80% had microalbuminuria or macroalbuminuria, and only 9.1% were free from any composite endpoints.
  
  
  CONCLUSIONS
  Subclinical microalbuminuria was associated with increased risk of cardiovascular events in CHF patients with mildly reduced or preserved renal function.
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sakata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miyata
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nochioka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takada
authors.forename: Soichiro
authors.initials: S
authors.lastname: Tadaki
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Ushigome
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamauchi
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology* / Q000652:urine; D015897:Comorbidity; D003404:Creatinine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000652:urine*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000652:urine
chemical_list: D003404:Creatinine