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Comorbid renal tubular damage and hypoalbuminemia exacerbate cardiac prognosis in patients with chronic heart failure

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Abstract

Background

Renal tubular damage (RTD) and hypoalbuminemia are risks for poor prognosis in patients with chronic heart failure (CHF). Renal tubules play a pivotal role in amino acid and albumin reabsorption, which maintain serum albumin levels. The aims of the present study were to (1) examine the association of RTD with hypoalbuminemia, and (2) assess the prognostic importance of comorbid RTD and hypoalbuminemia in patients with CHF.

Methods and results

We measured N-acetyl-β-D-glucosamidase (NAG) levels and the urinary β2-microglobulin to creatinine ratio (UBCR) in 456 patients with CHF. RTD was defined as UBCR ≥300 μg/g or NAG ≥14.2 U/g. There were moderate correlations between RTD markers and serum albumin (NAG, r = −0.428, P < 0.0001; UBCR, r = −0.399, P < 0.0001). Multivariate logistic analysis showed that RTD was significantly related to hypoalbuminemia in patients with CHF. There were 134 cardiac events during a median period of 808 days. The comorbidity of RTD and hypoalbuminemia was increased with advancing New York Heart Association functional class. Multivariate Cox proportional hazard regression analysis showed that the presence of RTD and hypoalbuminemia was associated with cardiac events. The net reclassification index was significantly improved by adding RTD and hypoalbuminemia to the basic risk factors.

Conclusion

Comorbid RTD and hypoalbuminemia are frequently observed and increase the risk for extremely poor outcome in patients with CHF.

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Acknowledgments

This study was supported, in part, by a grant-in-aid for Scientific Research (No. 26893025) from the Ministry of Education Culture, Sport, Science and Technology and a grant-in-aid from the global century center of excellence (COE) program of the Japan Society for the Promotion of Science.

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Authors and Affiliations

  1. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, Japan

    Yoichiro Otaki, Tetsu Watanabe, Hiroki Takahashi, Akira Funayama, Daisuke Kinoshita, Miyuki Yokoyama, Tetsuya Takahashi, Satoshi Nishiyama, Takanori Arimoto, Tetsuro Shishido, Takuya Miyamoto, Tsuneo Konta & Isao Kubota

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  1. Yoichiro Otaki
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  2. Tetsu Watanabe
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Correspondence to Tetsu Watanabe.

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Otaki, Y., Watanabe, T., Takahashi, H. et al. Comorbid renal tubular damage and hypoalbuminemia exacerbate cardiac prognosis in patients with chronic heart failure. Clin Res Cardiol 105, 162–171 (2016). https://doi.org/10.1007/s00392-015-0899-z

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