Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza University Hospital of Turin, Corso Bramante 88, 10126, Torino, Italy.
Division of Anestesiology, Città della Salute e della Scienza University Hospital of Turin, Corso Bramante 88, 10126, Torino, Italy.
Clin Res Cardiol. 2020 Oct;109(10):1251-1259. doi: 10.1007/s00392-020-01617-w. Epub 2020 Mar 6.
Diuretic resistance portends a poor prognosis in acute heart failure, especially in advanced stages. Early identification of a poor response to diuretics may help to improve treatment and outcomes. Spot natriuresis (UNa) at 2 h from the start of intravenous furosemide has been proposed as an early indicator of diuretic response. Our paper aimed to determine the role of early natriuresis in patients hospitalized with advanced chronic heart failure (ACHF) and high risk of diuretic resistance.
We performed a sub-analysis of the DRAIN trial, a randomized clinical trial on 80 patients with acute decompensation of ACHF (NYHA IV, EF ≤ 30%) with low systolic blood pressure (≤ 110 mmHg) and dilutional hyponatremia (sodium ≤ 135 mMol/L) at admission. Patients were divided into two groups according to spot urinary sodium excretion (high: UNa > 50 or low: ≤ 50 mEq/L) at 2 h from furosemide administration. Twenty-eight patients (35%) showed a low natriuretic response. As compared to the other patients, this group showed lower daily urinary output (2275 ± 790 vs 3849 ± 2034 mL, p < 0.001), lower body weight reduction after 48 h (1.55 ± - 1.66 vs - 3.55 ± - 2.93 kg, p < 0.001), higher incidence of worsening renal function (32% vs 10%, p 0.02) and increasing rather than reducing NT-proBNP at 72 h (p 0.02).
In patients with ACHF and dilutional hyponatremia, low natriuresis after furosemide is an early marker of poor diuretic response and correlates with higher NT-proBNP and higher incidence of worsening renal function at 72 h.
在急性心力衰竭中，利尿剂抵抗预示着预后不良，尤其是在晚期。早期识别利尿剂反应不良可能有助于改善治疗和预后。静脉注射呋塞米开始后 2 小时的即时尿钠排泄（UNa）已被提出作为利尿剂反应的早期指标。我们的论文旨在确定早期钠排泄在患有晚期慢性心力衰竭（ACHF）和利尿剂抵抗高风险的患者中的作用。
我们对 DRAIN 试验进行了亚分析，这是一项针对 80 例急性失代偿性 ACHF（NYHA IV，EF ≤ 30%）患者的随机临床试验，这些患者入院时血压低（≤ 110mmHg）和稀释性低钠血症（钠 ≤ 135 mMol/L）。根据呋塞米给药后 2 小时的即时尿钠排泄（高：UNa > 50 或低：≤ 50 mEq/L），将患者分为两组。28 例（35%）患者表现出低利尿反应。与其他患者相比，该组的每日尿量较低（2275 ± 790 与 3849 ± 2034 mL，p < 0.001），48 小时后体重减轻较少（1.55 ± - 1.66 与 - 3.55 ± - 2.93 kg，p < 0.001），肾功能恶化的发生率较高（32%与 10%，p = 0.02），72 小时时 NT-proBNP 升高而不是降低（p = 0.02）。
在患有 ACHF 和稀释性低钠血症的患者中，呋塞米后低钠排泄是利尿剂反应不良的早期标志物，与 72 小时时更高的 NT-proBNP 和更高的肾功能恶化发生率相关。
