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

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 (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 Conclusions Albuminuria measured at discharge was independently associated with subsequent kidney function decline, adverse kidney-related outcomes, and increased mortality.