Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge

Abstract

Aims Most studies examined spot urine sodium's (sUNa + ) prognostic utility during the early phase of acute heart failure (AHF) hospitalization. In AHF, sodium excretion is related to clinical status; therefore, we investigated the differences in the prognostic information of spot UNa + throughout the course of hospitalization for AHF (admission vs. discharge). Methods and resultsThe study population were AHF patients (n = 172), who survived the index hospitalization. We compared the relationship between early (on admission, at 24 and 48 h) and discharge sUNa + measurements with post-discharge study endpoints: composite of 1 year all-cause mortality and AHF rehospitalization (with time to first event analysis) as well as with each event in separation. There were 49 (28.5%) deaths, 40 (23.3%) AHF rehospitalizations, while the composite endpoint occurred in 69 (40.1%) during 1 year follow-up. The sUNa + had prognostic significance for the composite endpoint when assessed on admission, at 24 and at 48 h: hazard ratios (HRs) with 95% confidence intervals (CIs) (per 10 mmol/L) were 0.88 (0.82-0.94); 0.87 (0.81-0.91); 0.90 (0.84-0.96), all P < 0.005. In contrast to early, active decongestion phase, discharge sUNa + had no prognostic significance HR (95% CI) (per 10 mmol/L): 0.99 (0.93-1.06) P = 0.79 for the composite endpoint, which was independent from the dose of oral furosemide prescribed at that timepoint (average causal mediation effects: À0.38; P = 0.71). Similarly, discharge sUNa + was neither associated with 1 year mortality HR (95% CI) (per 10 mmol/L): 0.97 (0.89-1.05) P = 0.48 nor with AHF rehospitalizations HR (95% CI) (per 10 mmol/l): 1.03 (0.94-1.12), P = 0.56. The comparison of longitudinal profiles of sUNa + during hospitalization showed significantly higher values within the early, active decongestive phase in those who did not experience composite endpoint when compared with those who did: admission: 94 ± 34 vs. 76 ± 35; Day 1: 85 ± 36 vs. 65 ± 37; Day 2: 84 ± 37 vs. 67 ± 35, all P < 0.005 (mmol/L), respectively. There was no difference between those groups in discharge sUNa + : 73 ± 35 vs. 70 ± 35 P = 0.82 (mmol/L). Conclusions Spot UNa + assessed at early phase of hospitalization and at discharge have different prognostic significance, which confirms that it should be always interpreted along with clinical context.

Distinct renin/aldosterone activity profiles correlate with renal function, natriuretic response, decongestive ability and prognosis in acute heart failure

“…There was a significant increase of renin probably as a response to decongestion and reduction of extracellular volume along with sodium excretion during hospitalization, as renin teleologically is excreted in order to defend intravascular volume. This phenomenon has been previously described in the context of diuretic use and also may also explain the reduction of sodium excretion observed at discharge [7,[25][26][27]. In contrast, there was a trend for decrease of aldosterone within hospitalization.…”

Efficacy and Safety of Subcutaneous Infusion of Non-formulated Furosemide in Patients with Worsening Heart Failure: a Real-World Study

“…Furthermore, to the best of our knowledge, this is the first study reporting the short-term trajectory of two well-established surrogate markers of congestion (NT-proBNP and CA125) after SCF administration in ambulatory patients with WHF. Interestingly, the observed spot uNa+ trajectory and 30-day changes in lnNT-proBNP and lnCA125 were similar to those previously reported in AHF patients successfully treated with IV loop-diuretics [16][17][18].…”

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

“…It has recently been demonstrated that measuring tubular markers during the active decongestion phase diminishes their prognostic value [22,29,30]. The time of measurement also appears to impact the predictive usefulness of other tubular function markers [42]. However, our study focused on biomarker levels on discharge when decongestion has been achieved and patients are clinically stable.…”