Verbrugge Frederik H, Martens Pieter, Boonen Levinia, Nijst Petra, Verhaert David, Noyens Patrick, De Vusser Philip, Dupont Matthias, Tang W H Wilson, Mullens Wilfried
a Department of Cardiology , Ziekenhuis Oost-Limburg , Genk , Belgium.
b Doctoral School for Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.
Acta Cardiol. 2018 Aug;73(4):335-341. doi: 10.1080/00015385.2017.1385152. Epub 2017 Oct 3.
This study investigates spot urinary chloride concentration in euvolemic chronic heart failure (CHF) patients.
This prospective cohort study included 50 ambulatory CHF patients on maintenance loop diuretics without recent hospital admission, clinical signs of volume overload, or adjustment in neurohumoral blocker or diuretic therapy. Spot urinary samples were collected immediately after loop diuretic intake. Subsequently, loop diuretic dose was reduced with 50% or stopped if ≤40 mg furosemide equivalents. Successful down-titration was defined as persistent dose reduction after 7 d without body weight increase >1.5 kg.
Urinary chloride concentration was 3045 ± 1271 mg/L overall. Patients with higher versus lower urinary chloride concentrations took the same dose of loop diuretics [40 mg (20-40 mg) furosemide equivalents; p value = .509] and had similar plasma NT-proBNP levels [1179 ng/L (311-2195 ng/L) versus 900 ng/L (255-1622 ng/L), respectively; p value = .461]. Down-titration was successful in 72% versus 76%, respectively (p value = 1.000). At 30 d, loop diuretic dose remained reduced in 59% versus 76% of patients, respectively (p value = .238). The proportion of patients free from diuretic therapy was 45% versus 62% in the high versus low chloride concentration group (p value = .265).
Loop diuretic down-titration was successful in 3 out of 4 euvolemic CHF patients, irrespectively of urinary chloride concentration on spot samples collected after diuretic intake.
本研究调查了血容量正常的慢性心力衰竭（CHF）患者的随机尿氯浓度。
这项前瞻性队列研究纳入了50例接受维持性袢利尿剂治疗的门诊CHF患者，这些患者近期未住院、无容量超负荷的临床体征，且神经体液阻滞剂或利尿剂治疗未调整。在服用袢利尿剂后立即采集随机尿样。随后，将袢利尿剂剂量减少50%，如果呋塞米等效剂量≤40mg则停药。成功减量定义为7天后持续减少剂量且体重增加不超过1.5kg。
总体尿氯浓度为3045±1271mg/L。尿氯浓度较高与较低的患者服用相同剂量的袢利尿剂[40mg（20 - 40mg）呋塞米等效剂量；p值 = 0.509]，且血浆NT - proBNP水平相似[分别为1179ng/L（311 - 2195ng/L）和900ng/L（255 - 1622ng/L）；p值 = 0.461]。减量成功的比例分别为72%和76%（p值 = 1.000）。在第30天，分别有59%和76%的患者袢利尿剂剂量仍处于减少状态（p值 = 0.238）。高氯浓度组与低氯浓度组中无需利尿剂治疗的患者比例分别为45%和62%（p值 = 0.265）。
四分之三血容量正常的CHF患者袢利尿剂减量成功，与利尿剂摄入后采集的随机样本中的尿氯浓度无关。
