Orvosi Hetilap · Mar 8, 2026
Determination of albuminuria in the light of the first-line pharmacotherapy of heart failure with reduced ejection fraction
By Forrai Z, Schäffer PP, Gergely TG et al.
INTRODUCTION: Urine albumin-to-creatinine ratio (UACR) has strategic importance in cardio-kidney-metabolic syndrome and leads to worse prognosis in heart failure. OBJECTIVE: To assess the role of UACR measurement in a consecutive, hospitalized patient cohort with heart failure with reduced ejection fraction (HFrEF) and to analyze the effect on guideline-directed medical therapy implementation and all-cause mortality. METHODS: The data of 186 patients, hospitalized for HFrEF between 01. 09. 2023 and 01. 09. 2024, were analyzed retrospectively, who had UACR measured in-hospital (admission parameters: male: 75%, age: 60 [51-70] years, diabetes: 36%, NT-proBNP: 5982 [2624-10567] pg/mL, eGFR: 59 [47-75] mL/min/1.73 m2, RASi: 63%, βB: 63%, MRA: 44%, SGLT2i: 18%, quadruple therapy [RASi + βB + MRA + SGLT2i]: 15%). Based on UACR values, 3 groups were created - A1: <3 mg/mmol, A2: 3-30 mg/mmol, A3: >30 mg/mmol - and pharmacotherapy at discharge was compared among them. All-cause mortality and its predictors were investigated. RESULTS: The distribution of UACR categories were: 53%, 38%, and 9% (A1, A2, A3). Patients with A2/A3 albuminuria were characterized by lower ratio of de novo HFrEF, higher comorbidity burden and NT-proBNP. Advanced albuminuria was associated with a lower application ratio of HFrEF pharmacotherapy (RASi: 98% vs. 94% vs. 59%, βB: 95% vs. 89% vs. 71%, MRA: 100% vs. 94% vs. 59%, SGLT2i: 84% vs. 68% vs. 41%, quadruple therapy: 80% vs. 61% vs. 41%). All-cause mortality rates of patients with higher albuminuria were worse (7% vs. 20% vs. 29%, p = 0.026). However, in the univariate analysis, UACR had a prognostic effect, while in the multivariate model, age, systolic blood pressure and the use of triple therapy (RASi + βB + MRA)/quadruple therapy remained the independent predictors of all-cause mortality. CONCLUSIONS: Our results highlight the importance of UACR in the identification of high-risk HFrEF patients. Guideline-directed medical therapy implementation was possible among them as well, underscoring the need of continuous therapy-optimization in wide spectrum of albuminuria. Orv Hetil. 2026; 167(10): 383-395.