The utility of urine sodium-guided diuresis during acute decompensated heart failure.

IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Failure Reviews Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI:10.1007/s10741-024-10424-8
Hasan K Siddiqi, Zachary L Cox, Lynne W Stevenson, Kevin Damman, Jozine M Ter Maaten, Brian Bales, Jin H Han, Juan B Ivey-Miranda, JoAnn Lindenfeld, Karen F Miller, Henry Ooi, Veena S Rao, Kelly Schlendorf, Alan B Storrow, Ryan Walsh, Jesse Wrenn, Jeffrey M Testani, Sean P Collins
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Abstract

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.

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急性失代偿性心力衰竭期间尿钠指导性利尿的实用性。
对急性失代偿性心力衰竭(ADHF)住院患者进行利尿治疗以达到减充血的目的是治疗的核心目标。虽然已经尝试了多种方法来迅速实现充分的减充血,同时将不良反应降至最低,但没有任何一种利尿策略显示出其优越性,而且在做出这些决定时可利用的数据和指南也很少。观察性队列研究显示,尿钠排泄与 ADHF 住院后的预后之间存在关联。尿液化学成分(尿钠和尿肌酐)可指导 ADHF 期间的利尿剂滴定,多项随机临床试验旨在比较尿液化学成分指导的利尿策略和常规护理。本综述将总结目前有关利尿剂监测和滴定策略的文献,概述证据差距,并介绍近期完成和正在进行的临床试验,以弥补 ADHF 患者的这些差距,尤其关注尿钠指导策略的效用。
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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
期刊最新文献
Adrenal crisis-induced cardiogenic shock (ACCS): a comprehensive review. Congestion/decongestion in heart failure: what does it mean, how do we assess it, and what are we missing?-is there utility in measuring volume? Treating heart failure by targeting the vagus nerve. The utility of urine sodium-guided diuresis during acute decompensated heart failure. Pharmacological management of heart failure in adults with congenital heart disease.
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