Serial direct sodium removal in patients with heart failure and diuretic resistance.

Autor: Rao VS; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Ivey-Miranda JB; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.; Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico., Cox ZL; Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA.; Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA., Moreno-Villagomez J; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.; Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico., Ramos-Mastache D; Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico., Neville D; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Balkcom N; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Asher JL; Division of Comparative Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA., Bellumkonda L; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Bigvava T; Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia., Shaburishvili T; Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia., Bartunek J; Cardiovascular Center, OLV Hospital, Aalst, Belgium., Wilson FP; Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.; Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, CT, USA., Finkelstein F; Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA., Maulion C; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Turner JM; Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA., Testani JM; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2024 May; Vol. 26 (5), pp. 1215-1230. Date of Electronic Publication: 2024 Mar 31.
DOI: 10.1002/ejhf.3196
Abstrakt: Aims: Loop diuretics may exacerbate cardiorenal syndrome (CRS) in heart failure (HF). Direct sodium removal (DSR) using the peritoneal membrane, in conjunction with complete diuretic withdrawal, may improve CRS and diuretic resistance.
Methods and Results: Patients with HF requiring high-dose loop diuretics were enrolled in two prospective, single-arm studies: RED DESERT (n = 8 euvolaemic patients), and SAHARA (n = 10 hypervolaemic patients). Loop diuretics were withdrawn, and serial DSR was utilized to achieve and maintain euvolaemia. At baseline, participants required a median 240 mg (interquartile range [IQR] 200-400) oral furosemide equivalents/day, which was withdrawn in all participants during DSR (median time of DSR 4 weeks [IQR 4-6]). Diuretic response (queried by formal 40 mg intravenous furosemide challenge and 6 h urine sodium quantification) increased substantially from baseline (81 ± 37 mmol) to end of DSR (223 ± 71 mmol, p < 0.001). Median time to re-initiate diuretics was 87 days, and the median re-initiation dose was 8% (IQR 6-10%) of baseline. At 1 year, diuretic dose remained substantially below baseline (30 [IQR 7.5-40] mg furosemide equivalents/day). Multiple dimensions of kidney function such as filtration, uraemic toxin excretion, kidney injury, and electrolyte handling improved (p < 0.05 for all). HF-related biomarkers including N-terminal pro-B-type natriuretic peptide, carbohydrate antigen-125, soluble ST2, interleukin-6, and growth differentiation factor-15 (p < 0.003 for all) also improved.
Conclusions: In patients with HF and diuretic resistance, serial DSR therapy with loop diuretic withdrawal was feasible and associated with substantial and persistent improvement in diuretic resistance and several cardiorenal parameters. If replicated in randomized controlled studies, DSR may represent a novel therapy for diuretic resistance and CRS.
Clinical Trial Registration: RED DESERT (NCT04116034), SAHARA (NCT04882358).
(© 2024 European Society of Cardiology.)
Databáze: MEDLINE
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