Albuminuria in Adults With Congenital Heart Disease

Mar 27, 2018
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Authors:
Rajpal S, Alshawabkeh L, Almaddah N, et al.
Citation:
Association of Albuminuria With Major Adverse Outcomes in Adults With Congenital Heart Disease: Results From the Boston Adult Congenital Heart Biobank. JAMA Cardiol 2018;Mar 14:[Epub ahead of print].
Summary By:
Timothy B. Cotts, MD, FACC

Study Questions:

What is the prevalence and significance of albuminuria in adults with congenital heart disease (ACHD)?

Methods:

A prospective study was performed at a single center using the Boston ACHD Biobank. Albuminuria was defined as a urine albumin-to-creatinine ratio of 30 mg/g or more.

Results:

A total of 612 patients (50.3% female, mean age 38.6 ± 13.4 years) were studied. Albuminuria was present in 106 patients (17.3%) and was associated with older age, presence of diabetes mellitus, lower estimated glomerular filtration rate, and cyanosis. After a mean follow-up time of 270 ± days, 17 patients (2.5%) died, while 68 (11.1%) either died or required overnight hospital admission. Albuminuria predicted the composite endpoint, with 28.3% of patients with albuminuria affected as compared with 7.5% of patients without albuminuria. Albuminuria was associated with increased risk of adverse outcomes only in patients with biventricular circulation and not in those with single-ventricle circulation. Among 133 patients (21.7%) in New York Heart Association (NYHA) functional class II, albuminuria was strongly associated with death or nonelective hospitalization.

Conclusions:

Albuminuria is common and is associated with increased risk for adverse outcomes in ACHD patients with biventricular circulation.

Perspective:

While albuminuria has been shown to have prognostic value in adults with acquired heart disease, this is the first study to demonstrate its role in ACHD. Previous studies have also shown a relatively high rate of albuminuria in patients with cyanotic CHD. This study assessed the broad range of adult congenital lesions seen at an ACHD referral center. It is interesting to note that the prognostic value only held up for patients with a ventricular circulation. This area deserves further study. Additionally, albuminuria appears to be particularly predictive for patients with biventricular circulation and NYHA functional class II. There may be a role for screening such patients to identify patients at higher risk and therefore a need for closer monitoring or more aggressive management.

Keywords: Albumins, Albuminuria, Creatinine, Cyanosis, Diabetes Mellitus, Glomerular Filtration Rate, Heart Defects, Congenital, Heart Failure, Outcome Assessment, Health Care, Risk


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