Published Online
on October 22, 2009

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Original Article

Prevalence and Prognostic Value of Elevated Urinary Albumin Excretion in Patients with Chronic Heart Failure. Data from the GISSI-Heart Failure (GISSI-HF) Trial

Serge Masson^1,11; Roberto Latini¹; Valentina Milani¹; Luciano Moretti²; Maria Grazia Rossi³; Emanuele Carbonieri⁴; Anna Frisinghelli⁵; Calogero Minneci⁶; Massimiliano Valisi⁷; Aldo P. Maggioni⁸; Roberto Marchioli⁹; Gianni Tognoni⁹ and Luigi Tavazzi¹⁰

¹ Istituto Mario Negri, Milan, Italy;
² Ospedale Mazzoni, Ascoli Piceno, Italy;
³ CardioCentro Ticino, Lugano, Switzerland;
⁴ Ospedale Fracastoro, San Bonifacio, Italy;
⁵ Ospedale Passirana, Garbagnate Milanese, Italy;
⁶ Ospedale San Giovanni di Dio, Florence, Italy;
⁷ Fleming Research, Milan, Italy;
⁸ ANMCO Research Center, Florence, Italy;
⁹ Consorzio Mario negri Sud, S. Maria Imbaro, Italy;
¹⁰ GVM Hospitals of care and Research, Cotignola, Italy

^* Corresponding author; email: masson{at}marionegri.it

Background—Increased urinary excretion of albumin is an early sign of kidney damage and a risk factor for progressive cardiovascular and renal diseases and heart failure (HF). There is however, only limited information on the prevalence and prognostic role of urinary albumin excretion in patients with established chronic HF.

Methods and Results—A total of 2131 patients enrolled in 76 sites participating in the GISSI-Heart Failure trial provided a first morning spot sample of urine at any of the clinical visits scheduled in the trial to calculate the urinary albumin-to-creatinine ratio (UACR). The relation between log-transformed UACR and all-cause mortality (428 deaths, time from urine collection to event or censoring) was evaluated with Cox multivariable models adjusted for all significant risk factors at the time of urine collection, in the study population and in patients without diabetes or hypertension. Almost 75% of the patients had normal urinary albumin excretion but 19.9% had microalbuminuria [30-299 mg/g creatinine] and 5.4% overt albuminuria [300 mg/g]. There was a progressive, significant increase in the adjusted rate of mortality in the study population (HR [95%CI] = 1.12 [1.05-1.18] per 1 unit increase of log(UACR), p=0.0002) and in the subgroup of patients without diabetes or hypertension. Randomized treatments (n-3 polyunsaturated fatty acids or rosuvastatin) had no major impact on albumin excretion.

Conclusions—Independently of diabetes, hypertension or renal function, elevated albumin excretion is a powerful prognostic marker in patients with chronic HF.

Key Words: heart failure • kidney • prognosis • microalbuminuria