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Title: | Natriuretic Response Is Highly Variable and Associated With 6-Month Survival Insights From the ROSE-AHF Trial | Authors: | Hodson, Daniel Z. Griffin, Matthew Mahoney, Devin Raghavendra, Parinita Ahmad, Tariq Turner, Jeffrey Wilson, F. Perry Tang, W. H. Wilson Rao, Veena S. Collins, Sean P. MULLENS, Wilfried Testani, Jeffrey M. |
Issue Date: | 2019 | Publisher: | ELSEVIER SCI LTD | Source: | JACC-HEART FAILURE, 7(5), p. 383-391 | Abstract: | OBJECTIVES This study sought to describe sodium excretion in acute decompensated heart failure (ADHF) clearly and to evaluate the prognostic ability of urinary sodium and fluid-based metrics. BACKGROUND Sodium retention drives volume overload, with fluid retention largely a passive, secondary phenomenon. However, parameters (urine output, body weight) used to monitor therapy in ADHF measure fluid rather than sodium balance. Thus, the accuracy of fluid-based metrics hinges on the contested assumption that urinary sodium content is consistent. METHODS Patients enrolled in the ROSE-AHF (Renal Optimization Strategies Evaluation-Acute Heart Failure) trial with 24-h sodium excretion available were studied (n = 316). Patients received protocol-driven high-dose loop diuretic therapy. RESULTS Sodium excretion through the first 24 h was highly variable (range 0.12 to 19.8 g; median 3.63 g, interquartile range: 1.85 to 6.02 g) and was not correlated with diuretic agent dose (r = 0.06; p = 0.27). Greater sodium excretion was associated with reduced mortality in a univariate model (hazard ratio: 0.80 per doubling of sodium excretion; 95% confidence interval: 0.66 to 0.95; p = 0.01), whereas gross urine output (p = 0.43), net fluid balance (p = 0.87), and weight change (p = 0.11) were not. Sodium excretion of less than the prescribed dietary sodium intake (2 g), even in the setting of a negative net fluid balance, portended a worse prognosis (hazard ratio: 2.02; 95% confidence interval: 1.17 to 3.46; p = 0.01). CONCLUSIONS In patients hospitalized with ADHF who were receiving high-dose loop diuretic agents, sodium concentration and excretion were highly variable. Sodium excretion was strongly associated with 6-month mortality, whereas traditional fluid-based metrics were not. Poor sodium excretion, even in the context of fluid loss, portends a worse prognosis. | Notes: | [Hodson, Daniel Z.; Griffin, Matthew; Mahoney, Devin; Raghavendra, Parinita; Ahmad, Tariq; Rao, Veena S.; Testani, Jeffrey M.] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT USA. [Turner, Jeffrey; Wilson, F. Perry] Yale Univ, Sch Med, Sect Nephrol, New Haven, CT USA. [Tang, W. H. Wilson] Cleveland Clin, Lerner Coll Med, Dept Cardiovasc Med, Cleveland, OH 44106 USA. [Collins, Sean P.] Vanderbilt Univ, Med Ctr, Dept Emergency Med, Nashville, TN USA. [Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Genk Biomed Res Inst, Dept Cardiol,Ziekenhuis Oost Limburg, Diepenbeek, Belgium. | Keywords: | body weight;diuretic agents;heart failure;sodium excretion | Document URI: | http://hdl.handle.net/1942/30232 | ISSN: | 2213-1779 | e-ISSN: | 2213-1787 | DOI: | 10.1016/j.jchf.2019.01.007 | ISI #: | 000466501900002 | Rights: | 2019 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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