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<p>The spot urinary potassium-to-creatinine (uK/uCr) ratio has been proposed as a surrogate for 24-h potassium excretion, but its clinical determinants and prognostic significance in heart failure (HF) remain unclear. We evaluated the clinical variables associated with the uK/uCr ratio and its relationship with long-term mortality in ambulatory HF patients. We ambispectively analyzed 1,145 patients from a single-center HF clinic. A multivariable linear regression model was used to identify factors independently associated with the uK/uCr ratio, and Cox models assessed its prognostic value. Mean age was 73.2 ± 11.3 years, 41.5% were women, and 52.0% had HF with preserved ejection fraction. Median NT-proBNP and uK/uCr were 1324 (447–2952) pg/mL and 48 (36–62) mmol/g creatinine, respectively. Higher uK/uCr was independently associated with estimated glomerular filtration rate (28.3% of R<sup>2</sup>), furosemide dose (20.6%), BUN (16.5%), age (13.5%), and NT-proBNP (8.2%). Each 10-unit increase in uK/uCr was associated with increased all-cause (HR 1.031; 95% CI: 1.006–1.056; <i>p</i> = 0.014) and cardiovascular mortality (HR 1.039; 95% CI: 1.021–1.057; <i>p</i> &lt; 0.001). In conclusion, the uK/uCr ratio reflects renal function, diuretic intensity, and neurohormonal activation, and is an independent predictor of mortality, suggesting its potential role in risk stratification and therapeutic decision-making in HF.</p>

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Urinary potassium/urinary creatinine ratio in outpatients with heart failure: factors associated and prognostic implications

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月14日

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  • Gema Miñana,
  • Neus Valls,
  • Miguel Lorenzo,
  • Gonzalo Núñez,
  • Rafael de la Espriella,
  • Anna Mollar,
  • Enrique Santas,
  • Eduardo Núñez,
  • Ernesto Valero,
  • Vicent Bodí,
  • Juan Sanchis,
  • Jose Luis Górriz,
  • Antoni Bayés-Genís,
  • Jan Biegus,
  • Julio Núñez

摘要

The spot urinary potassium-to-creatinine (uK/uCr) ratio has been proposed as a surrogate for 24-h potassium excretion, but its clinical determinants and prognostic significance in heart failure (HF) remain unclear. We evaluated the clinical variables associated with the uK/uCr ratio and its relationship with long-term mortality in ambulatory HF patients. We ambispectively analyzed 1,145 patients from a single-center HF clinic. A multivariable linear regression model was used to identify factors independently associated with the uK/uCr ratio, and Cox models assessed its prognostic value. Mean age was 73.2 ± 11.3 years, 41.5% were women, and 52.0% had HF with preserved ejection fraction. Median NT-proBNP and uK/uCr were 1324 (447–2952) pg/mL and 48 (36–62) mmol/g creatinine, respectively. Higher uK/uCr was independently associated with estimated glomerular filtration rate (28.3% of R2), furosemide dose (20.6%), BUN (16.5%), age (13.5%), and NT-proBNP (8.2%). Each 10-unit increase in uK/uCr was associated with increased all-cause (HR 1.031; 95% CI: 1.006–1.056; p = 0.014) and cardiovascular mortality (HR 1.039; 95% CI: 1.021–1.057; p < 0.001). In conclusion, the uK/uCr ratio reflects renal function, diuretic intensity, and neurohormonal activation, and is an independent predictor of mortality, suggesting its potential role in risk stratification and therapeutic decision-making in HF.