Albuminuria as a diagnostic criterion and a therapeutic target in heart failure and other cardiovascular disease - Review article

Sep 29, 2026

Chronic kidney disease, heart failure, and related cardiovascular diseases form a high-burden, bidirectional clinical nexus that requires earlier diagnosis and improved risk assessment. Although guidelines recommend screening and detection strategies, real-world adoption remains limited. Urine albumin-to-creatinine ratio (uACR) serves as a diagnostic and prognostic marker, and uACR changes act as surrogate outcomes for kidney and cardiovascular endpoints. This review evaluates the effectiveness and clinical implications of uACR screening.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Introduction

CKD and CVD disease burden and overlap

Limitations of current kidney biomarkers (eGFR)

Albuminuria as a biomarker and surrogate outcome

Role of uACR in detection and risk assessment

European Journal of Heart Failure (2025) 27, 2357–2371 REVIEW ARTICLE doi:10.1002/ejhf.3683 Albuminuria as a diagnostic criterion and a therapeutic target in heart failure and other cardiovascular disease Biykem Bozkurt 1*, Patrick Rossignol2,3,4,5, and Joseph A. Vassalotti6,7 1 Department of Medicine, Cardiology Section, Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA; 2 Université de Lorraine, Centre d’Investigations Cliniques-Plurithématique 1433 CHRU de Nancy, U1116 Inserm and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; 3 Medicine and Nephrology-Dialysis Departments, Princess Grace Hospital, Monaco, Monaco; 4 Monaco Private Hemodialysis Centre, Monaco, Monaco; 5 M-CRIN (Monaco Clinical Research Infrastructure Network), Monaco, Monaco; 6 Icahn School of Medicine at Mount Sinai, New York, NY, USA; and 7 National Kidney Foundation, Inc, New York, NY, USA Received 22 January 2025; revised 1 April 2025; accepted 17 April 2025 ; online publish-ahead-of-print 27 May 2025 The high disease burden and bidirectional relationship of chronic kidney disease (CKD), heart failure (HF) and other cardiovascular disease (CVD) necessitate the need for early diagnosis of these diseases. While current screening and detection methods are recommended by CKD and CVD guidelines, their adoption in practice is low. Urine albumin-to-creatinine ratio (uACR) is recognized as a diagnostic marker for CKD and a prognostic marker for CKD progression, HF and CVD outcomes, therefore albuminuria changes have been accepted as a surrogate outcome for kidney and cardiovascular endpoints. Furthermore, clinical trials investigating guideline-directed medical therapies have shown that uACR reductions are accompanied by risk reductions for cardiovascular, HF and other CKD outcomes. However, uACR isnot routinely measured in patients at risk of kidney and heart disease, and its utility for detection, risk stratification and prediction models may not be fully appreciated in routine clinical practice. This review will discuss the effectiveness and implications of uACR screening as a method for heart and kidney disease diagnosis and risk assessment. .......................................................................................................... *Corresponding author. Department of Medicine, Cardiology Section, Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA. Email: [bbozkurt@bcm.edu](bbozkurt@bcm.edu) © 2025 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Graphical Abstract The value of uACR. CKD, chronic kidney disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; uACR, urine albumin-to-creatinine ratio. .......................................................................................................... Keywords Cardiovascular disease • Chronic kidney disease • Detection • Diagnosis • Heart failure • Risk assessment • Screening • Urine albumin-to-creatinine ratio Introduction Individually, chronic kidney disease (CKD) and cardiovascular disease (CVD) are associated with substantial global disease burden. 1,2 Pre-existing CKD increases the risk of developing CVD and heart failure (HF) (Figure 1).3–14 CKD is also highly prevalent in people with CVD, and is the cause of approximately 1.9 million cardiovascular (CV)-related deaths annually.15 Approximately 50% of people with stage G4–5 CKD (estimated glomerular filtration rate [eGFR] 15

FAQs

Why are chronic kidney disease and heart failure linked in clinical practice?

The document describes a bidirectional relationship between CKD and heart failure and other cardiovascular disease, contributing to substantial global disease burden.

What role does urine albumin-to-creatinine ratio (uACR) play?

uACR is presented as a diagnostic marker for CKD and a prognostic marker for CKD progression, heart failure, and cardiovascular outcomes, with albuminuria changes used as surrogate endpoints.

Why might screening using current detection methods have low adoption?

Even though CKD and CVD guidelines recommend screening and detection methods, the document states that adoption in routine practice is low, and uACR is not routinely measured despite its utility.

Sep 29, 2026

Uploaded by Nguyễn Văn Học