Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/17759
Title: Urinary Composition During Decongestive Treatment in Heart Failure With Reduced Ejection Fraction
Authors: VERBRUGGE, Frederik 
NIJST, Petra 
DUPONT, Matthias 
PENDERS, Joris 
Tang, W. H. Wilson
MULLENS, Wilfried 
Issue Date: 2014
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Source: CIRCULATION-HEART FAILURE, 7 (5), p. 766-U149
Abstract: Background-The urinary composition, including sodium (Na+) and chloride (Cl-) concentrations, might provide useful information in addition to urine output during decongestive treatment in heart failure. Methods and Results-Consecutive patients with heart failure (n=61), ejection fraction <= 45%, worsening symptoms, and scheduled treatment with intravenous loop diuretics were included. Patients received protocol-driven therapy until complete decongestion, assessed clinically and by echocardiography. Three consecutive 24-hour urinary collections were performed. With 2 mg (1-4 mg), 1 mg (0-2 mg), and 1 mg (0-1 mg) bumetanide administered in bolus during consecutive 24-hour intervals, in addition to combinational diuretic therapy in approximate to 70% and both oral spironolactone and vasodilators in approximate to 90%, euvolemia was reached, often within 24 hours. Urine output was higher during the first when compared with the second or third 24-hour interval (2700 versus 1550 or 1375 mL, respectively; P<0.001), but this was no longer significant after correction for diuretic dose (P=0.263), indicating preserved diuretic efficiency during the study. In contrast, urinary Na+ and Cl- excretion both decreased significantly, even after correction for diuretic dose (P=0.040 and 0.004, respectively), leading to decreasing urinary concentrations with progressive decongestion. After reaching euvolemia, lower urinary Na+/Cr and Cl-/Cr ratios were both associated with urine output <= 1500 mL (area under the curve, 0.830 and 0.826, respectively; P<0.001 for both), in contrast to plasma N-terminal pro-B-type natriuretic peptide levels that were not (area under the curve, 0.515; P=0.735) Conclusions-The urinary composition during progressive decongestion in heart failure with reduced ejection fraction is characterized by a drop in urinary Na+ and Cl- concentrations. The urinary Na+/Cr or Cl-/Cr ratio might provide insightful information to titrate diuretic therapy.
Notes: [Verbrugge, Frederik H.; Nijst, Petra; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, B-3600 Genk, Belgium. [Verbrugge, Frederik H.; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Penders, Joris; Mullens, Wilfried] Hasselt Univ, Biomed Res Inst, Fac Med & Life Sci, Diepenbeek, Belgium. [Penders, Joris] Ziekenhuis Oost Limburg, Dept Lab Med, B-3600 Genk, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH USA.
Keywords: sodium; systolic heart failure; urea; urine;sodium; systolic heart failure; urea; urine
Document URI: http://hdl.handle.net/1942/17759
ISSN: 1941-3289
e-ISSN: 1941-3297
DOI: 10.1161/CIRCHEARTFAILURE.114.001377
ISI #: 000342490900011
Rights: © 2014 American Heart Association, Inc.
Category: A1
Type: Journal Contribution
Validations: ecoom 2015
Appears in Collections:Research publications

Show full item record

SCOPUSTM   
Citations

45
checked on Sep 3, 2020

WEB OF SCIENCETM
Citations

51
checked on Dec 2, 2022

Page view(s)

52
checked on Jul 20, 2022

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.