Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
Sci Rep. 2024 Jan 17;14(1):1494. doi: 10.1038/s41598-024-51744-x.
The decongestion ability in response to diuretic treatment plays a crucial role in the treatment of acute heart failure. This effectiveness is evaluated through the assessment of sodium concentration and urine volume, which are also treatment goals themselves. However, the bidirectional interconnection between these factors remains not fully understood. The objective of this study is to provide mechanistic insights into the correlation between spot urine sodium concentrations (UNa) and urine dilution. This aims to better understand of the decongestive abilities in acute heart failure (AHF). The study was single-center, prospective, conducted on a group of 50 AHF patients. Each participant received a standardized furosemide dose of 1 mg per kg of body weight. Hourly diuresis was measured in the first 6 h of the study, and urine composition was assessed at predefined timepoints. The study group presented the exponential (rather than linear) pattern of relationship between UNa and 6-h urine volume, whereas relationship between eGFR and 6-h urine volume was linear (r = 0.61, p < 0.001). The relationship between UNa and all other analyzed indices of urine dilution, including the change from baseline in urine creatinine concentration, urine osmolarity, and urine osmolarity corrected for urine sodium, also exhibited an exponential relationship. Patients who were chronically exposed to furosemide demonstrated a significantly lower urine dilution (1.78 [1.18-3.54] vs 11.58 [3.9-17.88]; p < 0.001) in comparison to naïve individuals. In conclusion, it should be noted that in AHF higher UNa is associated with disproportionally higher urine dilution, and patients naïve to furosemide have significantly greater ability to dilute urine when compare to chronic furosemide users.
利尿剂治疗的消肿能力在急性心力衰竭的治疗中起着至关重要的作用。这种有效性通过评估钠浓度和尿量来评估，这也是治疗目标本身。然而，这些因素之间的双向相互关系仍不完全清楚。本研究的目的是提供对即时尿钠浓度（UNa）与尿液稀释之间相关性的机制见解。这旨在更好地了解急性心力衰竭（AHF）的消肿能力。该研究为单中心、前瞻性研究，共纳入 50 名 AHF 患者。每位参与者接受 1 毫克/公斤体重的标准呋塞米剂量。在研究的前 6 小时内测量每小时尿量，并在预定时间点评估尿液成分。研究组呈现出 UNa 与 6 小时尿量之间的指数（而非线性）关系模式，而 eGFR 与 6 小时尿量之间的关系呈线性（r=0.61，p<0.001）。UNa 与所有其他分析的尿液稀释指标之间的关系，包括尿肌酐浓度、尿渗透压和尿渗透压校正后的尿钠的基线变化，也呈现出指数关系。与初次接受呋塞米治疗的患者相比，长期接受呋塞米治疗的患者尿液稀释明显减少（1.78[1.18-3.54]vs 11.58[3.9-17.88]；p<0.001）。总之，需要注意的是，在 AHF 中，较高的 UNa 与不成比例的更高尿液稀释相关，与初次接受呋塞米治疗的患者相比，慢性接受呋塞米治疗的患者具有显著更大的尿液稀释能力。
