The utility of urine sodium-guided diuresis during acute decompensated heart failure.

Veena S Rao, Jesse Wrenn, Jeffrey M Testani, Kevin Damman, Jozine M Ter Maaten, Hasan K Siddiqi, Sean P Collins, Ryan Walsh, Kelly Schlendorf, Karen F Miller, Henry Ooi, JoAnn Lindenfeld, Juan B Ivey-Miranda, Jin H Han, Brian Bales, Lynne W Stevenson, Zachary L Cox, Alan B Storrow

Journal: Heart failure reviews 2024;29(6):1161-1173

PMID: 39128947

Free Full Text on PubMed Central View on PubMed

Abstract

Diuresis to achieve decongestion is a central aim of therapy in patients hospitalized for acute decompensated heart failure (ADHF). While multiple approaches have been tried to achieve adequate decongestion rapidly while minimizing adverse effects, no single diuretic strategy has shown superiority, and there is a paucity of data and guidelines to utilize in making these decisions. Observational cohort studies have shown associations between urine sodium excretion and outcomes after hospitalization for ADHF. Urine chemistries (urine sodium ± urine creatinine) may guide diuretic titration during ADHF, and multiple randomized clinical trials have been designed to compare a strategy of urine chemistry-guided diuresis to usual care. This review will summarize current literature for diuretic monitoring and titration strategies, outline evidence gaps, and describe the recently completed and ongoing clinical trials to address these gaps in patients with ADHF with a particular focus on the utility of urine sodium-guided strategies.

Address: Department of Medicine, Vanderbilt University Medical Center, North Tower, 1215 21st Avenue South, 5th Floor, Office 5033C, Nashville, TN, 37232-8802, USA. [email protected].; Department of Pharmacy, Lipscomb University College of Pharmacy, Nashville, TN, USA.; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA.; Department of Medicine, Vanderbilt University Medical Center, North Tower, 1215 21st Avenue South, 5th Floor, Office 5033C, Nashville, TN, 37232-8802, USA.; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.; Geriatric, Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.; Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico.; Department of Medicine, Vanderbilt University Medical Center, North Tower, 1215 21st Avenue South, 5th Floor, Office 5033C, Nashville, TN, 37232-8802, USA.; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.

DOI: 10.1007/s10741-024-10424-8

Link outs

Free resources

Full Text Sources:

https://pmc.ncbi.nlm.nih.gov/articles/pmid/3912894...

Medical:

https://medlineplus.gov/heartfailure.html

Subscription / membership required

Full Text Sources:

https://doi.org/10.1007/s10741-024-10424-8

MeSH Terms: Humans, Heart Failure, Diuresis, Sodium, Diuretics, Acute Disease