Associations of albuminuria in patients with chronic heart failure: Findings in the ALiskiren Observation of heart Failure Treatment study

Aims: To examine the relationships between baseline characteristics and urinary albumin excretion in the extensively phenotyped patients in the ALiskiren Observation of heart Failure Treatment ( ALOFT ) study. Methods and results: Urinary albumin creatinine ratio ( UACR ) was available in 190 of 302 ( 63% ) patients randomized in ALOFT. Of these, 107 ( 56% ) had normal albumin excretion, 63 ( 33% ) microalbuminuria, and 20 ( 11% ) macroalbuminuria. Compared with patients with normoalbuminuria, those with microalbuminuria had a greater prevalence of diabetes ( 48 vs. 26%, P = 0.005 ) and a lower estimated glomerular filtration rate ( eGFR ) ( 60.7 vs. 68.3 mL/min/1.73 m2, P = 0.01 ). Patients with macroalbuminuria had additional differences from those with a normal UACR, including younger age ( 63 vs. 69 years, P = 0.02 ), higher glycated haemoglobin ( HbA1c; 7.9 vs. 6.2%, P < 0.001 ), and different echocardiographic findings. Of the non-diabetic patients, 28% had microalbuminuria and 7% had macroalbuminuria. Independent predictors of UACR in these patients included N-terminal pro B-type natriuretic peptide ( NT-proBNP ), HbA1c, and left ventricular diastolic dimension. Increased UACR was not associated with markers of inflammation or of renin angiotensin aldosterone system activation and was not reduced by aliskiren. Conclusions: Increased UACR is common in patients with heart failure, including non-diabetics. Urinary albumin creatinine ratio is independently associated with HbA1c and NT-proBNP, even in non-diabetic patients.