Albuminuria and Diabetes Predict Worse Outcomes in HFpEF Patients, finds study

The majority of HFpEF patients have a metabolic phenotype with comorbid conditions like diabetes and kidney dysfunction as the determining factor. Poor glucose metabolism and early kidney disease, especially with the presence of albuminuria, have progressively emerged as predominant predictors of clinical decline in HFpEF. Data on the long-term prognostic implications of these factors in HFpEF, however, are sparse.

332 consecutive HFpEF patients who were referred to an outpatient clinic between March 2015 and November 2023 were studied. Type 1 diabetic patients were excluded. Participants were divided into four groups according to their glucose metabolism and albuminuria status at baseline:

• DM−/ALB− (no albuminuria or diabetes): 121 patients (36.4%)

• DM+/ALB− (diabetes but no albuminuria): 106 patients (31.9%)

• DM−/ALB+ (albuminuria but no diabetes): 44 patients (13.3%)

• DM+/ALB+ (both diabetes and albuminuria): 61 patients (18.4%)

The main outcome was a composite of heart failure hospitalization (HFH) and all-cause mortality, evaluated with multivariable Cox regression models during a median follow-up of about 3 years.

Results

• Both diabetes and albuminuria were independently linked with poorer outcomes at baseline.

• The adjusted hazard ratio (aHR) for the presence of diabetes was 1.93 (95% CI, 1.25–2.97), and for albuminuria it was 1.58 (95% CI, 1.04–2.41).

• Patients with both diabetes and albuminuria (DM+/ALB+) had the greatest risk of adverse outcomes, with an aHR of 2.85 (95% CI, 1.57–5.15).

After one year, 250 patients (75%) had follow-up data available. During this period:

• 3.9% of patients developed new diabetes

• 22% developed new albuminuria

• 25.2% of patients experienced a change in albuminuria status

• 10.8% recovered from albuminuria

Notably, at 3 years, the primary outcome was more common in patients who:

• Had albuminuria continuously: 27.1%

• Recovered from albuminuria: 22.2%

• Developed albuminuria after one year: 13.9%

• Were albuminuria-free: 8.6%

• The group differences were statistically significant (p = 0.008), highlighting the persistent prognostic significance of albuminuria irrespective of timing.

The research concludes that both albuminuria and diabetes are common and prognostically important in patients with HFpEF. New-onset DM and albuminuria still develop even after a year. The findings necessitate vigilant monitoring and active management of glucose and renal function in HFpEF treatment.

Reference:

Vranken, N.P.A., Li, X., Bouman, H. et al. Temporal prevalence and prognostic impact of diabetes mellitus and albuminuria in heart failure with preserved ejection fraction. Cardiovasc Diabetol 24, 156 (2025). https://doi.org/10.1186/s12933-025-02708-6