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.

Authors

Yuka Akama, Yu Suresvar Singh, Taisuke Nakade, Yudai Fujimoto, Tomomi Ide, Keisuke Kida, Shouji Matsushima, Nobuyuki Enzan, Masataka Ikeda, Takeshi Kitai, Tatsunori Taniguchi, Takahiro Okumura, Takeshi Tohyama, Hiroyuki Tsutsui, Toshiharu Ninomiya, Tohru Minamino, Jozine M Ter Maaten, Kevin Damman, Adriaan A Voors, Yuya Matsue

Published in

Journal of cardiac failure. Sep 30, 2026. Epub Sep 30, 2026.

Abstract

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.
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 (<30 mg/gCr), A2 (30-300 mg/gCr), or A3 (>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.
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 < 0.001). The composite kidney-related endpoint occurred in 195 patients (6.3%), with higher risk in A2 (odds ratio [OR] 1.83; 95% confidence interval [CI] 1.27-2.61; P = 0.001) and A3 (OR 3.69; 95% CI 2.48-5.44; P < 0.001) compared to A1. Higher UACR categories were independently associated with increased mortality (A2 vs A1, Hazard ratio [HR] 1.37; 95% CI 1.12-1.67; P = 0.002; A3 vs A1, HR 1.45; 95% CI 1.12-1.87; P = 0.005).
Albuminuria measured at discharge was independently associated with subsequent kidney function decline, adverse kidney-related outcomes, and increased mortality.

PMID:
42815792
Bibliographic data and abstract were imported from PubMed on 01 Oct 2026.

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