Department of Medicine, Vanderbilt University Medical Center, North Tower, 1215 21st Avenue South, 5th Floor, Office 5033C, Nashville, TN, 37232-8802, USA.
Department of Pharmacy, Lipscomb University College of Pharmacy, Nashville, TN, USA.
Heart Fail Rev. 2024 Nov;29(6):1161-1173. doi: 10.1007/s10741-024-10424-8. Epub 2024 Aug 12.
Diuresis to achieve decongestion is a central aim of therapy in patients hospitalized for acute decompensated heart failure (ADHF). While multiple approaches have been tried to achieve adequate decongestion rapidly while minimizing adverse effects, no single diuretic strategy has shown superiority, and there is a paucity of data and guidelines to utilize in making these decisions. Observational cohort studies have shown associations between urine sodium excretion and outcomes after hospitalization for ADHF. Urine chemistries (urine sodium ± urine creatinine) may guide diuretic titration during ADHF, and multiple randomized clinical trials have been designed to compare a strategy of urine chemistry-guided diuresis to usual care. This review will summarize current literature for diuretic monitoring and titration strategies, outline evidence gaps, and describe the recently completed and ongoing clinical trials to address these gaps in patients with ADHF with a particular focus on the utility of urine sodium-guided strategies.
利尿以实现充血消退是急性失代偿性心力衰竭（ADHF）住院患者治疗的核心目标。虽然已经尝试了多种方法来快速实现充分的充血消退，同时将不良反应降至最低，但没有单一的利尿策略显示出优越性，而且在做出这些决策时缺乏数据和指南。观察性队列研究表明，ADHF 住院后尿钠排泄与结局之间存在关联。尿化学物质（尿钠±尿肌酐）可指导 ADHF 期间的利尿剂滴定，并且已经设计了多项随机临床试验来比较尿化学指导的利尿策略与常规治疗。这篇综述将总结利尿剂监测和滴定策略的现有文献，概述证据空白，并描述最近完成和正在进行的临床试验，以解决 ADHF 患者的这些空白，特别关注尿钠指导策略的实用性。
