The role of urine sodium in acutely decompensated heart failure.

Autor:	Hoen M; Department of Cardiology, Zuyderland MC, Heerlen, the Netherlands., Hofman DE; Department of Cardiology, Zuyderland MC, Heerlen, the Netherlands., Hompes BHA; Department of Cardiology, Zuyderland MC, Heerlen, the Netherlands., Peeters LEE; Department of Cardiology, Zuyderland MC, Heerlen, the Netherlands., Langenveld B; Department of Cardiology, Zuyderland MC, Heerlen, the Netherlands., van Kimmenade RRJ; Department of Cardiology, Radboudumc, Nijmegen, the Netherlands., Frenken LAM; Department of Internal Medicine, Zuyderland MC, Heerlen, the Netherlands., Lenderink T; Department of Cardiology, Zuyderland MC, Heerlen, the Netherlands., Brunner-La Rocca HP; Department of Cardiology, MUMC+, Maastricht, the Netherlands., Sanders-Van Wijk S; Department of Cardiology, Zuyderland MC, Heerlen, the Netherlands.
Jazyk:	angličtina
Zdroj:	International journal of cardiology. Heart & vasculature [Int J Cardiol Heart Vasc] 2024 Sep 19; Vol. 55, pp. 101509. Date of Electronic Publication: 2024 Sep 19 (Print Publication: 2024).
DOI:	10.1016/j.ijcha.2024.101509
Abstrakt:	Background: Diuretic resistance is common and results in poor outcome. Spot urine sodium (UrNa) is suggested as a tool to tailor diuretics and improve efficacy of therapy. We prospectively evaluate the prevalence of diuretic resistance, predictors of low spot-UrNa and the prognostic value of spot-UrNa in an unselected ADHF population. Methods: Patients admitted for ADHF and treated with iv diuretics were included. Spot-UrNa was collected 2 h after administration of an IV diuretic bolus. The main endpoint was a composite of HF re-hospitalizations and all-cause mortality at 90 days follow-up. Results: 143 patients were included in this study (median age 81 [75 - 85] years, 55 % male), of which 50 % were newly diagnosed with HF. Low spot-UrNa was independently associated with worse renal function, low serum sodium, and systolic blood pressure, previous loop diuretic and SGLT2i use and loop diuretic administered dose. Both absolute spot-UrNa (HR 0.87, 95 % CI 0.79 - 0.95, P=0.003 per 10 mmol/L increase) and a urinary sodium ≥ 100 mmol/l (HR=0.51, 95 % CI 0.27 - 0.97, P=0.04) significantly predicted the composite endpoint. This association was no longer significant after correction for confounders. Patients with low spot-UrNa attained longer IV diuretic treatment and a higher cumulative IV diuretic dose. Conclusions: Spot-UrNa is prevalent and occurs more often in patients with more progressed cardio-renal disease. Spot-UrNa significantly predicts 90-day HF hospital-free survival in ADHF. Further studies are needed evaluating the effect of UrNa guided diuretic treatment on clinical endpoints. Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [R.R.J.K. reports research grants from the Dutch Heart Foundation and Netherlands Heart Institute; personal consultancy fees from Novartis Pharma and Bayer; and personal lecture fees from Novartis Pharma and Bayer. H.P.B.L.R. has declared grants from Roche Diagnostics and Vifor Pharma; consulting fees from Boehringer-Ingelheim, Roche Diagnostics and Novartis; lecture payment from Boehringer-Ingelheim, AstraZeneca, Novo Nordisk, Novartis and Vifor Pharma; Participation on a Data Safety Monitoring Board of Advisory Board for Roche Diagnostics, Vifor Pharma and CeleCor Therapeutics; and leadership roles in IHI project iCARE4CVD (no. 101112022) and Interreg-NEW supported project PASSIN-HF NWE702. S.S.W. has received grants from Cardio Research Limburg, Boehringer Ingelheim, Astrazeneca and Roche Diagnostics; Consulting fees from Boehringer Ingelheim and Roche Diagnostics; lecture payment from Boehringer Ingelheim, Novartis, AstraZeneca and Roche diagnostics and is a board member of the WCN (Dutch Scientific Cardiology Network) and Stichting Perfusie. T.L. has received an unrestricted grant from AstraZeneca]. (© 2024 The Authors.)
Databáze:	MEDLINE
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