Albuminuria is associated with worse outcomes in non‐diabetics hospitalized with acute heart failure

Aims Chronic kidney disease (CKD) increases the risk of morbidity and mortality in patients with heart failure (HF). Guidelines recommend assessing CKD using the urinary albumin‐to‐creatinine ratio (UACR), as albuminuria is strongly associated with the risk of incident HF and outcomes in chronic HF; however, its prognostic role in acute HF (AHF) remains unclear. We evaluated if albuminuria was associated with adverse outcomes in individuals hospitalized with AHF in Renal Optimization Strategies Evaluation‐Acute Heart Failure (ROSE‐AHF). Methods There were 339 participants with baseline UACR, 248 with UACR at Day 7 and 237 with both measurements for assessing change in UACR. Associations of baseline, Day 7 and change in UACR with all‐cause mortality at 6 months and the composite of first HF hospitalization or cardiovascular mortality at 2 months were assessed with Cox proportional hazards models. We assessed for effect modification by treatment arm and diabetes status. Results The mean age was 70 years, 73.2% were male, 55.8% had diabetes mellitus, the mean estimated glomerular filtration rate was 45 mL/min/1.73 m 2 and mean UACR was 208 mg/g. There were 65 deaths and 82 HF hospitalizations or cardiovascular deaths. Baseline UACR was not associated with either outcome; however, there was a significant interaction by diabetes status for all‐cause mortality ( P = 0.022) such that baseline UACR was associated with the risk of death in non‐diabetics [hazard ratio (HR) 2.58, 95% CI 1.00, 6.66, P = 0.050 third tertile versus first tertile], but not diabetics. Neither Day 7 UACR nor the change in UACR were associated with outcomes. Conclusions Albuminuria is largely not associated with the risk of death, cardiovascular death, or HF hospitalization in AHF, except admission UACR is associated with the risk of death in non‐diabetics.