In the current issue of JAMA Cardiology, Rajpal et al1 discuss the association of albuminuria with outcomes in adult patients with congenital heart disease (ACHD). We can best understand the findings of authors in the context of our evolving understanding of the prognostic value of albuminuria in heart disease. Albuminuria has been shown to be associated with cardiovascular events in patients with diabetes, hypertension, and chronic kidney disease.2 Of interest, reductions in estimated glomerular filtration rate (eGFR) and albumin level have been found to be independent and additive risk factors for cardiovascular events, a finding suggesting that they may reflect different pathological processes.3 However, the risk posed by albuminuria extends beyond diabetes and hypertension. Assessment of patients presenting with heart failure demonstrated elevated prevalence and predictive value of albuminuria for cardiovascular events even in nondiabetic, normotensive patients4; this result was not surprising given our understanding of the cardiorenal axis.
Andrew de Freitas R. Association of Albuminuria With Outcomes in Adults With Congenital Heart Disease. JAMA Cardiol. 2018;3(4):316–317. doi:10.1001/jamacardio.2018.0126
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