Alattar Fadi T, Imran Nasha't, Debari Vincent A, Mallah Kozhaya N, Shamoon Fayez E
Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth;
Exp Clin Cardiol. 2010 Fall;15(3):e65-9.
Renal impairment (RI), defined as an increase in creatinine level of greater than 26.5 mmol/L, develops in more than 30% of acute decompensated heart failure (ADHF) patients. Fractional excretion of sodium (FeNa) reflects sodium handling by the kidneys during diuresis.
To study the relationship between FeNa and RI in patients admitted with ADHF.
The hospital course and renal function of all ADHF patients admitted to the hospital were prospectively observed. Patients were included if their admission creatinine level was 176 mmol/L or lower, they had been on a low-salt diet since admission, had urine sodium and creatinine samples collected more than 6 h after a furosemide dose in the first few days of admission, and they were on daily intravenous furosemide doses of 20 mg or more.
Over six months, 51 patients met the inclusion criteria; the average daily dose of intravenous furosemide was 58.8 mg. RI developed in 39% of patients. A FeNa cut-off point of 0.4% was determined using ROC curve analysis; patients with a FeNa of greater than 0.4% (28 patients) were compared with patients with a lower FeNa (23 patients). Admission creatinine level and furosemide dose were higher in the first group (P=0.01 and P=0.06, respectively). The first group developed RI more frequently (OR=6.3; 95% CI 1.7 to 23.5; P=0.0047; adjusted OR for admission creatinine = 6.18; 95% CI 1.6 to 24.5; P=0.0096; and adjusted OR for furosemide dose = 4.7; 95% CI 1.3 to 16.7; P=0.016). They had a longer hospitalization course (median nine days [interquartile range 6.3 to 13.5 days] versus seven days [interquartile range 4.0 to 9.0 days]; P=0.036) and they were admitted to the cardiac care unit more frequently (OR=6.8; 95% CI 1.3 to 34.9; P=0.02).
A FeNa of greater than 0.4% more than 6 h after a dose of diuretics predicts RI and a complicated hospital course in ADHF patients.
肾功能损害（RI）定义为肌酐水平升高超过26.5 mmol/L，在超过30%的急性失代偿性心力衰竭（ADHF）患者中出现。钠分数排泄（FeNa）反映利尿期间肾脏对钠的处理情况。
研究ADHF入院患者中FeNa与RI之间的关系。
对所有入院的ADHF患者的住院病程和肾功能进行前瞻性观察。纳入标准为入院时肌酐水平为176 mmol/L或更低，自入院起接受低盐饮食，入院头几天在使用速尿剂量后6小时以上采集尿钠和肌酐样本，且每日静脉注射速尿剂量为20 mg或更多。
在六个月期间，51例患者符合纳入标准；静脉注射速尿的平均日剂量为58.8 mg。39%的患者出现了RI。使用ROC曲线分析确定FeNa的截断点为0.4%；将FeNa大于0.4%的患者（28例）与FeNa较低的患者（23例）进行比较。第一组的入院肌酐水平和速尿剂量更高（分别为P = 0.01和P = 0.06）。第一组更频繁地出现RI（OR = 6.3；95% CI 1.7至23.5；P = 0.0047；调整后的入院肌酐OR = 6.18；95% CI 1.6至24.5；P = 0.0096；调整后的速尿剂量OR = 4.7；95% CI 1.3至16.7；P = 0.016）。他们的住院病程更长（中位数九天[四分位间距6.3至1113.5天]对七天[四分位间距4.0至9.0天]；P = 0.036），并且更频繁地入住心脏监护病房（OR = 6.8；95% CI 1.3至34.9；P = 0.02）。
利尿剂给药后6小时以上FeNa大于0.4%可预测ADHF患者的RI和复杂的住院病程。
