Fujimoto Yudai, Kitai Takeshi, Nasu Takahito, Matsumoto Shingo, Naruse Yoshihisa, Hioki Hirofumi, Shimizu Masato, Yonetsu Taishi, Horiuchi Yu, Matsue Yuya
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
J Cardiol. 2025 Jul 3. doi: 10.1016/j.jjcc.2025.06.018.
The dynamics and prognostic value of diuretic metrics in response to initial intravenous (IV) diuretic therapy in patients with acute heart failure (AHF) remain unclear. We assessed the association between urinary sodium concentration, diuretic response (DR) following IV furosemide administration, and their prognostic implications in patients with AHF.
The diuretic resistance measured by sodium excretion and urine output (DIURESIS)-AHF study was a prospective, multicenter, observational study that assessed spot urinary sodium concentrations at 0/1/2 h, total urine output, and urinary sodium excretion achieved within the first 6 h following initial IV furosemide administration. The DR was measured using the urine output or sodium excretion per 40 mg of IV furosemide.
Ninety-six patients with AHF (mean age, 78 years; men, 56 %) were included. Urine sodium concentrations at 1/2 h showed high inter- and intra-patient variabilities. A lower DR based on 6-h sodium excretion was independently associated with a higher incidence of composite outcome, even after adjusting for known risk factors (/10-mmol increase; hazard ratio: 0.96, 95 % confidence interval: 0.93-0.99, p = 0.011); the DR measured by urine output was not.
Urine sodium concentrations at 1/2 h after initial IV furosemide showed great inter- and intra-patient variabilities, and lower DR using 6-h sodium excretion after IV furosemide was associated with a poor prognosis in patients with AHF.
急性心力衰竭（AHF）患者初始静脉注射（IV）利尿剂治疗时利尿指标的动态变化及预后价值仍不明确。我们评估了尿钠浓度、静脉注射呋塞米后的利尿反应（DR）及其对AHF患者的预后影响之间的关联。
通过钠排泄和尿量测量利尿抵抗的AHF研究（DIURESIS-AHF研究）是一项前瞻性、多中心、观察性研究，评估了初始静脉注射呋塞米后0/1/2小时的即时尿钠浓度、总尿量以及6小时内的尿钠排泄量。使用每40毫克静脉注射呋塞米的尿量或钠排泄量来测量DR。
纳入了96例AHF患者（平均年龄78岁；男性占56%）。1/2小时时的尿钠浓度在患者间和患者内均显示出高度变异性。即使在调整已知危险因素后，基于6小时钠排泄量的较低DR与复合结局的较高发生率独立相关（每增加10毫摩尔；风险比：0.96，95%置信区间：0.93-0.99，p = 0.011）；通过尿量测量的DR则不然。
初始静脉注射呋塞米后1/2小时的尿钠浓度在患者间和患者内均有很大变异性，且静脉注射呋塞米后使用6小时钠排泄量得出的较低DR与AHF患者的不良预后相关。
