Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Madrid, Spain.
Clin Cardiol. 2023 Aug;46(8):906-913. doi: 10.1002/clc.24040. Epub 2023 Jun 7.
Patients with acute heart failure (AHF) require intensification in the diuretic strategy. However, the optimal diuretic strategy remains unclear. In this work, we aimed to evaluate the role of urinary potassium to creatinine ratio (K/Cr) to predict diuretic and natriuretic response to thiazide or mineralocorticoid receptor antagonists (MRAs) in a cohort of patients with AHF and preserved ejection fraction (AHF-pEF).
Patients with a high urinary K/Cr ratio will have a better diuretic and natriuretic response with spironolactone versus chlorthalidone.
This is a study of 44 patients with AHF-pEF with suboptimal loop diuretic response. The primary endpoint was the baseline K/Cr associated with natriuretic and diuretic effect of chlorthalidone versus spironolactone at 24 and 72 h. Mixed linear regression models were used to analyze the endpoints. Estimates were reported as least squares mean with their respective 95% confidence interval (CIs).
The median age of the study population was 85 years (82.5-88.5), and 30 (68.2%) were women. The inferential multivariate analysis suggested a greater natriuretic and diuretic effect of chlorthalidone across K/Cr levels. In the upper category, chlorthalidone translated into a statistically increase in natriuresis at 24 and 72 h. Chlorthalidone versus spironolactone showed ∆uNa of 25.7 mmol/L at 24 h (95% CI = -3.7 to 55.4, p = .098) and ∆uNa of 24.8 mmol/L at 72 h (95% CI = -4 to 53.6, p = .0106). The omnibus p value is .027. Multivariate analyses revealed a significant increase in 72 h cumulative diuresis irrespective of K/Cr status in those on chlorthalidone.
In patients with AHF-pEF and suboptimal diuretic response, diuresis and natriuresis are higher with the administration of chlorthalidone over spironolactone. These data don't support the hypothesis that the K/Cr ratio can help guide the choice of thiazide diuretic versus MRA in AHF-pEF patients on loop diuretic.
急性心力衰竭（AHF）患者需要强化利尿剂策略。然而，最佳的利尿剂策略仍不清楚。在这项工作中，我们旨在评估尿钾与肌酐比值（K/Cr）在射血分数保留的心力衰竭（AHF-pEF）患者队列中预测噻嗪类或盐皮质激素受体拮抗剂（MRAs）的利尿和利钠反应的作用。
尿 K/Cr 比值高的患者使用螺内酯与氯噻酮相比将有更好的利尿和利钠反应。
这是一项对 44 例 AHF-pEF 患者的研究，这些患者对袢利尿剂反应不佳。主要终点是基线 K/Cr 与氯噻酮和螺内酯在 24 和 72 小时的利钠和利尿作用相关。混合线性回归模型用于分析终点。估计值以最小二乘均数及其相应的 95%置信区间（CIs）报告。
研究人群的中位年龄为 85 岁（82.5-88.5），30 名（68.2%）为女性。推断的多变量分析表明，氯噻酮在 K/Cr 水平上具有更大的利钠和利尿作用。在上部类别中，氯噻酮在 24 小时和 72 小时的利钠作用呈统计学上增加。与螺内酯相比，氯噻酮在 24 小时时的尿钠增加了 25.7mmol/L（95%CI=-3.7 至 55.4，p=0.098），在 72 小时时的尿钠增加了 24.8mmol/L（95%CI=-4 至 53.6，p=0.0106）。整体 p 值为.027。多变量分析显示，无论 K/Cr 状态如何，氯噻酮治疗的 72 小时累积尿量均有显著增加。
在 AHF-pEF 且利尿剂反应不佳的患者中，与螺内酯相比，氯噻酮的利尿和利钠作用更高。这些数据不支持 K/Cr 比值可帮助指导噻嗪类利尿剂与 AHF-pEF 患者中 MRA 选择的假设。
