دورية أكاديمية
Natriuretic Response Is Highly Variable and Associated With 6-Month Survival Insights From the ROSE-AHF Trial
| العنوان: | Natriuretic Response Is Highly Variable and Associated With 6-Month Survival Insights From the ROSE-AHF Trial |
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| المؤلفون: | Hodson, Daniel Z., Griffin, Matthew, Mahoney, Devin, Raghavendra, Parinita, Ahmad, Tariq, Turner, Jeffrey, Wilson, F. Perry, Tang, W. H. Wilson, Rao, Veena S., Collins, Sean P., Mullens, Wilfried, Testani, Jeffrey M. |
| بيانات النشر: | ELSEVIER SCI LTD |
| سنة النشر: | 2019 |
| المجموعة: | Document Server@UHasselt (Universiteit Hasselt) |
| مصطلحات موضوعية: | body weight, diuretic agents, heart failure, sodium excretion |
| الوصف: | OBJECTIVES This study sought to describe sodium excretion in acute decompensated heart failure (ADHF) clearly and to evaluate the prognostic ability of urinary sodium and fluid-based metrics. BACKGROUND Sodium retention drives volume overload, with fluid retention largely a passive, secondary phenomenon. However, parameters (urine output, body weight) used to monitor therapy in ADHF measure fluid rather than sodium balance. Thus, the accuracy of fluid-based metrics hinges on the contested assumption that urinary sodium content is consistent. METHODS Patients enrolled in the ROSE-AHF (Renal Optimization Strategies Evaluation-Acute Heart Failure) trial with 24-h sodium excretion available were studied (n = 316). Patients received protocol-driven high-dose loop diuretic therapy. RESULTS Sodium excretion through the first 24 h was highly variable (range 0.12 to 19.8 g; median 3.63 g, interquartile range: 1.85 to 6.02 g) and was not correlated with diuretic agent dose (r = 0.06; p = 0.27). Greater sodium excretion was associated with reduced mortality in a univariate model (hazard ratio: 0.80 per doubling of sodium excretion; 95% confidence interval: 0.66 to 0.95; p = 0.01), whereas gross urine output (p = 0.43), net fluid balance (p = 0.87), and weight change (p = 0.11) were not. Sodium excretion of less than the prescribed dietary sodium intake (2 g), even in the setting of a negative net fluid balance, portended a worse prognosis (hazard ratio: 2.02; 95% confidence interval: 1.17 to 3.46; p = 0.01). CONCLUSIONS In patients hospitalized with ADHF who were receiving high-dose loop diuretic agents, sodium concentration and excretion were highly variable. Sodium excretion was strongly associated with 6-month mortality, whereas traditional fluid-based metrics were not. Poor sodium excretion, even in the context of fluid loss, portends a worse prognosis. ; This work was supported by National Institutes of Health (NIH) grants K23HL114868, L30HL115790, R01HL139629, R21HL143092, R01HL128973 (Dr. Testani), K23DK097201 (Dr. ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 2213-1787 |
| العلاقة: | JACC-HEART FAILURE, 7(5), p. 383-391; http://hdl.handle.net/1942/30232Test; 391; 383; 000466501900002 |
| DOI: | 10.1016/j.jchf.2019.01.007 |
| الإتاحة: | https://doi.org/10.1016/j.jchf.2019.01.007Test http://hdl.handle.net/1942/30232Test |
| رقم الانضمام: | edsbas.80F35698 |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 22131787 |
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| DOI: | 10.1016/j.jchf.2019.01.007 |