6533b85cfe1ef96bd12bc110
RESEARCH PRODUCT
Early urinary sodium trajectory and risk of adverse outcomes in acute heart failure and renal dysfunction.
Gema MiñanaPau LlàcerAnna MollarRuth SánchezJulio NúñezLorenzo FácilaEduardo NúñezEnrique SantasGonzalo NúñezJosé María NúñezAntoni Bayes-genisJuana María VaquerFrancisco J. ChorroVicent BodíJosé Luis GórrizJuan SanchisRafael De La EspriellaSergio García-blasSilvia Venturasubject
medicine.medical_specialtyRenal failureTratamiento diuréticoAntígeno carbohidrato 125medicine.medical_treatmentRenal function030204 cardiovascular system & hematologyInsuficiencia cardiaca agudaGastroenterologylaw.invention03 medical and health sciences0302 clinical medicineRandomized controlled triallawInterquartile rangeInternal medicineBiomarker-guided therapyEnsayo clínicoTerapia guiada por biomarcadoresClinical endpointHumansMedicineDiureticsAgedAged 80 and overHeart Failurebusiness.industryFallo renalSodiumAcute heart failureGeneral Medicinemedicine.diseaseClinical trialClinical trialAcute heart failure Antígeno carbohidrato 125 Biomarker-guided therapy Carbohydrate antigen 125 Clinical trial Diuretic treatment Ensayo clínico Fallo renal Insuficiencia cardiaca aguda Renal failure Terapia guiada por biomarcadores Tratamiento diuréticoCarbohydrate antigen 125Heart failureAcute DiseaseDiuretic treatmentBiomarker (medicine)Kidney DiseasesDiureticbusinessdescription
Introduction and objectives: Urinary sodium (UNa+) has emerged as a useful biomarker of poor clinical outcomes in acute heart failure (AHF). Here, we sought to evaluate: a) the usefulness of a single early determination of UNa+ for predicting adverse outcomes in patients with AHF and renal dysfunction, and b) whether the change in UNa+ at 24 hours (Delta UNa24 h) adds any additional prognostic information over baseline values. Methods: This is a post-hoc analysis of a multicenter, open-label, randomized clinical trial (IMPROVE-HF) (ClinicalTrials.gov NCT02643147) that randomized 160 patients with AHF and renal dysfunction on admission to a) the standard diuretic strategy, or b) a carbohydrate antigen 125-guided diuretic strategy. The primary end point was all-cause mortality and total all-cause readmissions. Results: The mean age was 78 +/- 8 years, and the mean glomerular filtration rate was 34.0 +/- 8.5 mL/min/1.73 m(2). The median UNa+ was 90 (65-111) mmol/L. At a median follow-up of 1.73 years [interquartile range, 0.48-2.35], 83 deaths (51.9%) were registered, as well as 263 all-cause readmissions in 110 patients. UNa+ was independently associated with mortality (HR, 0.75; 95%CI, 0.65-0.87; P 50 mmol/L. Conclusions: In patients with AHF and renal dysfunction, a single early determination of UNa+ <= 50 mmol/L identifies patients with a higher risk of all-cause mortality and readmission. The Delta UNa24 h adds prognostic information over baseline values only when UNa+ at admission is <= 50 mmol/L. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-01-01 |