Spot urine sodium excretion as prognostic marker in acutely decompensated heart failure: the spironolactone effect

Ferreira, João Pedro; Girerd, Nicolas; Santos, Mário; Carvalho, Henrique; Bettencourt, Paulo; Kénizou, David; Butler, Javed; Zannad, Faı̈ez; Rossignol, Patrick

doi:10.1007/s00392-015-0945-x

Cited by 37 publications

(28 citation statements)

References 59 publications

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“…[3][4][5] Additionally, patients who develop WHF experience prolonged hospital lengths of stay and increased mortality. [6][7][8][9][10] It would be valuable to be able to identify diuretic non-responders in the first 2 or 3 h to escalate therapy in order to relieve symptoms, avoid WHF, and potentially reduce length of hospital stay. [6][7][8][9][10] It would be valuable to be able to identify diuretic non-responders in the first 2 or 3 h to escalate therapy in order to relieve symptoms, avoid WHF, and potentially reduce length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

“…8,11 A protocol to determine diuretic responsiveness based on urinary sodium measurements in the first 6 h after diuretic administration was recently reported. However, its association with near-term and inpatient events was less clear.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 There are a number of proposed definitions of diuretic responsiveness, but no definition allows early identification of this in the emergency department (ED) or shortly after hospital admission. [6][7][8][9][10] It would be valuable to be able to identify diuretic non-responders in the first 2 or 3 h to escalate therapy in order to relieve symptoms, avoid WHF, and potentially reduce length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

“…However, its association with near-term and inpatient events was less clear. 8,11 A protocol to determine diuretic responsiveness based on urinary sodium measurements in the first 6 h after diuretic administration was recently reported. 12 This study was conducted in the inpatient setting, where subjects were enrolled up to 4 days after admission.…”

Section: Introductionmentioning

confidence: 99%

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Early urine electrolyte patterns in patients with acute heart failure

et al. 2018

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AimsWe conducted a prospective study of emergency department (ED) patients with acute heart failure (AHF) to determine if worsening HF (WHF) could be predicted based on urinary electrolytes during the first 1–2 h of ED care. Loop diuretics are standard therapy for AHF patients. A subset of patients hospitalized for AHF will develop a blunted natriuretic response to loop diuretics, termed diuretic resistance, which often leads to WHF. Early detection of diuretic resistance could facilitate escalation of therapy and prevention of WHF.Methods and resultsPatients were eligible if they had an ED AHF diagnosis, had not yet received intravenous diuretics, had a systolic blood pressure > 90 mmHg, and were not on dialysis. Urine electrolytes and urine output were collected at 1, 2, 4, and 6 h after diuretic administration. Worsening HF was defined as clinically persistent or WHF requiring escalation of diuretics or administration of intravenous vasoactives after the ED stay. Of the 61 patients who qualified in this pilot study, there were 10 (16.3%) patients who fulfilled our definition of WHF. At 1 h after diuretic administration, patients who developed WHF were more likely to have low urinary sodium (9.5 vs. 43.0 mmol; P < 0.001) and decreased urine sodium concentration (48 vs. 80 mmol/L; P = 0.004) than patients without WHF. All patients with WHF had a total urine sodium of <35.4 mmol at 1 h (100% sensitivity and 60% specificity).ConclusionsOne hour after diuretic administration, a urine sodium excretion of <35.4 mmol was highly suggestive of the development of WHF. These relationships require further testing to determine if early intervention with alternative agents can prevent WHF.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early urine electrolyte patterns in patients with acute heart failure

et al. 2018

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“…The proposed formula has been validated in 20 patients having both glycemic and albumin measurement; a wider application is probably mandatory to confirm our results. We did not collect spot urine to evaluate sodium levels, which are probably able to determine dilution and outcome [31]. We did not consider cases of hyponatremia that were induced by treatment.…”

Section: Limitationsmentioning

confidence: 99%

Hyponatremia in Acute Heart Failure in Relation to Hematocrit Levels: Clinical Relevance and Prognostic Implication

et al. 2018

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Background: Hyponatremia is the most common electrolyte abnormality found in hospitalized patients with acute heart failure (AHF) and is related to poor prognosis. This study sought to evaluate: (1) the different prognostic impact of dilutional versus depletional hyponatremia, evaluating short- and long-term outcome; (2) the relationship between both types of hyponatremia and intravenous furosemide dose, renal function changes, and persistent congestion at discharge. Methods: This retrospective single-center study included 233 consecutive patients with a primary diagnosis of AHF. Hyponatremia was defined as serum sodium < 135 mEq/L, which could be either dilutional (hematocrit < 35%) or depletional (hematocrit ≥35%). Persistent congestion was defined as a congestion score ≥2 at discharge. Patients were followed 180 days for occurrence of death or rehospitalization for AHF. Results: Hyponatremia was present in 68/233 patients with 27 cases classified as dilutional hyponatremia versus 41 as depletional. The proportion of patients with persistent congestion was higher in the dilutional hyponatremia group, but similar in the depletional hyponatremia group (52 vs. 81 vs. 58%; p = 0.02). After adjustment for important baseline characteristics, dilutional hyponatremia was significantly associated with the risk of death or rehospitalization for AHF at 60 days (HR 2.17 [1.08–4.37]; p = 0.03) and 180 days (HR 1.88 [1.10–3.21]; p = 0.02). In contrast, depletional hyponatremia was only significantly associated with the same endpoint at 180 days (HR 1.64 [1.05–2.57]; p = 0.03). Conclusions: Low hematocrit levels in AHF patients with hyponatremia characterize a population that is more difficult to decongest and has poor clinical outcome. In contrast, patients with hyponatremia but normal hematocrit are better decongested and have better short-term outcome.

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Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology

Mullens

Damman

Testani

et al. 2020

European J of Heart Fail

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244

291

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Appropriate interpretation of changes in markers of kidney function is essential during the treatment of acute and chronic heart failure. Historically, kidney function was primarily assessed by serum creatinine and the calculation of estimated glomerular filtration rate. An increase in serum creatinine, also termed worsening renal function, commonly occurs in patients with heart failure, especially during acute heart failure episodes. Even though worsening renal function is associated with worse outcome on a population level, the interpretation of such changes within the appropriate clinical context helps to correctly assess risk and determine further treatment strategies. Additionally, it is becoming increasingly recognized that assessment of kidney function is more than just glomerular filtration rate alone. As such, a better evaluation of sodium and water handling by the renal tubules allows to determine the efficiency of loop diuretics (loop diuretic response and efficiency). Also, though neurohumoral blockers may induce modest deteriorations in glomerular filtration rate, their use is associated with improved long‐term outcome. Therefore, a better understanding of the role of cardio–renal interactions in heart failure in symptom development, disease progression and prognosis is essential. Indeed, perhaps even misinterpretation of kidney function is a leading cause of not attaining decongestion in acute heart failure and insufficient dosing of guideline‐directed medical therapy in general. This position paper of the Heart Failure Association Working Group on Cardio‐Renal Dysfunction aims at improving insights into the interpretation of renal function assessment in the different heart failure states, with the goal of improving heart failure care.

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Spot urine sodium excretion as prognostic marker in acutely decompensated heart failure: the spironolactone effect

Abstract: Spot urinary sodium levels >60 mmol/L and urinary sodium/potassium ratio >2 measured at day 3 of hospitalization for ADHF are associated with improved mid-term outcomes. Spironolactone is associated with increased spot urinary sodium and sodium/potassium ratio >2.

Cited by 37 publications

References 59 publications

Early urine electrolyte patterns in patients with acute heart failure

Early urine electrolyte patterns in patients with acute heart failure

Hyponatremia in Acute Heart Failure in Relation to Hematocrit Levels: Clinical Relevance and Prognostic Implication

Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology

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