Sharoubandi Seyed Hossein, Farahani Maryam Moshkani, Khosravi Arezoo, Rabanipour Najmeh
Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Science, Isfahan, Iran.
J Res Med Sci. 2025 Aug 30;30:41. doi: 10.4103/jrms.jrms_153_23. eCollection 2025.
Renal impairment (RI), the most common comorbidity in acute decompensated heart failure (ADHF) patients, leads to cardiorenal syndrome. Fractional excretion of sodium (FENa), an indicator of sodium handling by the kidney, is widely used to assess natriuresis, the underlying treatment of ADHF. The aim of this study was to investigate the association of FENa with RI and 1-year cardiovascular mortality.
This prospective study was implemented in the Persian Registry of Cardiovascular Disease/Heart Failure study context. Any individuals over 18 years suffering from ADHF admitted to the emergency department were eligible to be recruited in our study. We excluded the patients with previously untreated chronic comorbidities, who died during hospitalization, and without follow-up and other etiologies rather than cardiovascular diseases since discharge. Baseline demographic and clinical data gathered. RI was defined as a 0.3 mg/dL rise of creatinine during admission. The primary and secondary clinical outcomes were RI and cardiovascular mortality, respectively.
During the study period, 158 patients were recruited, with 103 (65.1%) developing RI and 25.68% of the population expired. Higher blood pressure, overall furosemide dose, as well as lower FENa, and serum creatinine on admission were prevalent among patients who developed RI. Greater serum sodium levels on admission and discharge, a lack of a history of ischemic heart disease, and hyponatremic status during admission were associated with a higher mortality rate. The Pearson correlations demonstrate the significant association of FENa with creatinine alterations ( = 0.001, = -0.47). The linear regression analysis demonstrates the significant association of FENa with creatinine alteration during admission ( = -1.43, 95% confidence interval [CI] [- 1.86, -1.002], = 0.001). Multiple logistic regression demonstrates no significant association of prediction of FENa with creatinine alterations (odds ratio [OR] =0.33, 95% CI [0.09-1.19], = 0.091). The logistic regression analysis revealed no association between FENa and 1-year mortality (OR = 0.85, 95% CI (0.26-2.75), = 0.79).
A lower FENa on admission indirectly predicts the development of RI in patients with ADHF. Meanwhile, FENa is unable to predict 1-year cardiovascular mortality.
肾功能损害（RI）是急性失代偿性心力衰竭（ADHF）患者中最常见的合并症，可导致心肾综合征。尿钠排泄分数（FENa）是肾脏处理钠的一个指标，广泛用于评估利钠作用，这是ADHF的基础治疗方法。本研究的目的是调查FENa与RI及1年心血管死亡率之间的关联。
本前瞻性研究是在波斯心血管疾病/心力衰竭注册研究的背景下开展的。任何年龄超过18岁、因ADHF入住急诊科的患者都有资格纳入我们的研究。我们排除了之前未治疗的慢性合并症患者、住院期间死亡的患者以及出院后无随访且有除心血管疾病以外其他病因的患者。收集了基线人口统计学和临床数据。RI定义为入院期间肌酐升高0.3mg/dL。主要和次要临床结局分别为RI和心血管死亡率。
在研究期间，共招募了158例患者，其中103例（65.1%）发生了RI，25.68%的患者死亡。发生RI的患者中，入院时血压较高、呋塞米总剂量较高、FENa较低以及血清肌酐水平较低较为常见。入院和出院时血清钠水平较高、无缺血性心脏病病史以及入院时低钠血症状态与较高的死亡率相关。Pearson相关性分析显示FENa与肌酐变化存在显著关联（P = 0.001，r = -0.47）。线性回归分析显示入院期间FENa与肌酐变化存在显著关联（β = -1.43，95%置信区间[CI][-1.86，-1.002]，P = 0.001）。多因素logistic回归分析显示FENa预测肌酐变化无显著关联（比值比[OR]=0.33，95%CI[0.09 - 1.19]，P = 0.091）。logistic回归分析显示FENa与1年死亡率无关联（OR = 0.85，95%CI（0.26 - 2.75），P = 0.79）。
入院时较低的FENa间接预测ADHF患者发生RI。同时，FENa无法预测1年心血管死亡率。
