Supplementary Material for: Trajectory of urine albumin-creatinine ratio in patients with acute heart failure (TACRAHF study)

Abstract
Introduction: Albuminuria is prevalent in patients with chronic heart failure and is a risk factor for disease progression. However, its clinical meaning in acute heart failure remains elusive. This study analyzed the trajectory of urine albumin to creatinine ratio (UACR) between admission and discharge and its association with decongestion.
Methods: In this prospective observational study, 63 patients were enrolled. UACR, B-type natriuretic peptide (BNP), and clinical congestion score (CCS) were obtained at admission and discharge. We used linear mixed regression analysis to compare changes in the natural logarithm of UACR (logUACR) and its association with changes in markers of decongestion. Estimates were reported as least squares mean (LSM) with their respective 95% CIs.
Results: The median age of the study population was 87 years, 68.5% were women, and 69.8% had a left ventricular ejection fraction >50%. LogUACR at discharge significantly decreased in the overall population compared to admission [Δ –0.47, 95% CI -0.78 to -0.15, p-value=0.003]. The magnitude of UACR drop at discharge was associated with changes in surrogate markers of decongestion. Patients who showed a greater reduction in BNP at discharge exhibited a greater reduction in UACR (p=0.016). The same trend was also found with clinical decongestion, as assessed by changes in CCS; however, without achieving statistical significance (p=0.171). UACR change at discharge was not associated with changes in serum creatinine (p-value=0.923).
Conclusion: In elderly patients with AHF and volume overload, the level of UACR significantly decreased upon discharge compared to admission. This reduction in UACR was closely linked to decreases in BNP.