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  • Albuminuria and...

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

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2025-04-11T09:00:50+05:30  |  Updated On 11 April 2025 11:28 AM IST
Albuminuria and Diabetes Predict Worse Outcomes in HFpEF Patients, finds study
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Researchers have established that both diabetes mellitus (DM) and albuminuria are prevalent in heart failure with preserved ejection fraction (HFpEF) patients and independently predict a greater risk of hospitalization and mortality. These results underscore the role of metabolic and renal markers in predicting unfavorable outcomes among this patient group. The research also determined that albuminuria, even if developed or resolved during follow-up, was still a powerful predictor of unfavorable outcomes in HFpEF. The study was conducted by Nousjka and fellow researchers published in BMC Cardiovascular Diabetology journal.

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

BMC Cardiovascular DiabetologyHFpEFalbuminuriadiabetesglucose metabolismheart failureprognosiskidney diseasecardiovascular outcomesrisk stratification
Source : BMC Cardiovascular Diabetology
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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