钠尿作为一种评估利尿剂治疗急性失代偿性心力衰竭有效性的方法:来自一项初步研究的数据

IF 0.3 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Rational Pharmacotherapy in Cardiology Pub Date : 2023-01-07 DOI:10.20996/1819-6446-2022-12-13
K. Charaya, D. Shchekochikhin, S. N. Tarasenko, N. Ananicheva, S. A. Sovetova, T. V. Soboleva, O. Dikur, A. Borenstein, D. Andreev
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The development of resistance to diuretics was taken as the primary endpoint (the need to increase the daily dose of furosemide by more than 2 times compared to the initial one or the addition of another class of diuretic drugs).Results. 25 patients with ADHF were included. The average age of patients was 69.0±14.8 years, 16 (64%) of them were men. The average left ventricular ejection fraction was 49.0±13.5%. The level of the N‐terminal fragment of the brain natriuretic peptide (NT-proBNP) was 3416 (2128; 5781) pg/ml. The average sodium concentration in the urine analysis obtained 2 hours after the start of treatment was 100.6±41.0 mmol / l. The concentration of sodium in urine for the first day was 102.2±39.0 mmol/l. 2 hours after the start of treatment, the sodium concentration in a single urine test was less than 50 mmol/l in 5 (20%) patients. Upon further observation, oligoanuria (defined as diuresis of less than 400 ml within 24 hours) developed in 2 of them. 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引用次数: 0

摘要

的目标。目的分析慢性心力衰竭急性失代偿(ADHF)患者首次使用利尿剂2小时后单次尿钠水平的临床意义。材料和方法。一项观察性研究是在一家快速护理医院进行的。静脉给予第一剂利尿剂2小时后的尿钠浓度分析和住院第一天的尿钠分析。以对利尿剂的耐药性为主要终点(与初始剂量相比,需要将速尿的日剂量增加2倍以上或添加另一类利尿剂)。纳入ADHF患者25例。患者平均年龄69.0±14.8岁,男性16例(64%)。平均左室射血分数为49.0±13.5%。脑利钠肽N端片段(NT-proBNP)的水平为3416 (2128;5781) pg / ml。治疗开始后2 h尿钠平均浓度为100.6±41.0 mmol/l,第1天尿钠平均浓度为102.2±39.0 mmol/l。治疗开始2小时后,5例(20%)患者单次尿钠浓度低于50 mmol/l。进一步观察,其中2例出现少尿(定义为24小时内利尿量小于400ml)。钠浓度大于50 mmol/l的患者无少尿。7例(28%)患者需要增加剂量(增加环形利尿剂剂量和/或添加另一类利尿剂);同时,我们诊断出其中5例(20%)出现利尿剂耐药性。利尿剂耐药在开始给药后2小时单次尿钠浓度低于50 mmol/l的患者中更为常见(p=0.037);当将招募的患者人群按单次尿钠浓度≥50 mmol/l和<50 mmol/l分为亚组时,利尿剂治疗升级的需求无显著差异[3 (60%)vs 4 (20%), p=0.07]。利尿剂耐药在首次给药后2小时单次尿钠浓度低于50 mmol / l的患者中更为常见。对尿钠的评估可以在治疗开始时确定利尿剂治疗的有效性不足。
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Natriuresis as a Way to Assess the Effectiveness of Diuretic Therapy for Acute Decompensated Heart Failure: Data from a Pilot Study
Aim. To analyze the clinical significance of the sodium level in a single urine test obtained 2 hours after the first dose of a loop diuretic was administered in patients with acute decompensation of chronic heart failure (ADHF).Material and methods. An observational study was conducted on the basis of a rapid-care hospital. The concentration of sodium in urine analysis obtained 2 hours after intravenous administration of the first dose of loop diuretic and natriuresis for the first day of hospitalization were evaluated. The development of resistance to diuretics was taken as the primary endpoint (the need to increase the daily dose of furosemide by more than 2 times compared to the initial one or the addition of another class of diuretic drugs).Results. 25 patients with ADHF were included. The average age of patients was 69.0±14.8 years, 16 (64%) of them were men. The average left ventricular ejection fraction was 49.0±13.5%. The level of the N‐terminal fragment of the brain natriuretic peptide (NT-proBNP) was 3416 (2128; 5781) pg/ml. The average sodium concentration in the urine analysis obtained 2 hours after the start of treatment was 100.6±41.0 mmol / l. The concentration of sodium in urine for the first day was 102.2±39.0 mmol/l. 2 hours after the start of treatment, the sodium concentration in a single urine test was less than 50 mmol/l in 5 (20%) patients. Upon further observation, oligoanuria (defined as diuresis of less than 400 ml within 24 hours) developed in 2 of them. Oligoanuria was not detected among patients whose sodium concentration was more than 50 mmol/l. The need for escalation (any increase in the dose of a loop diuretic and/or the addition of another class of diuretic drugs) arose in 7 (28%) patients; at the same time, we diagnosed the development of resistance to diuretics in 5 (20%) of them. Resistance to diuretics was more common among patients with a sodium concentration in a single urine test obtained 2 hours after the start of furosemide administration, less than 50 mmol/l (p=0.037); when dividing the recruited patient population into subgroups with a sodium concentration in a single urine test ≥50 mmol/l and <50 mmol/l there was no significant difference in the need for any escalation of diuretic therapy [3 (60%) vs 4 (20%), p=0.07].Conclusion. Resistance to diuretics is more common among patients with a sodium concentration in a single urine test obtained 2 hours after the first dose of furosemide, less than 50 mmol / l. Evaluation of natriuresis allows to identify insufficient effectiveness of diuretic therapy already at the beginning of treatment.
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来源期刊
Rational Pharmacotherapy in Cardiology
Rational Pharmacotherapy in Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.00
自引率
50.00%
发文量
79
审稿时长
6 weeks
期刊介绍: The primary goals of the Journal are consolidation of information on scientific and practical achievements in pharmacotherapy and prevention of cardiovascular diseases and continuing education of cardiologists and internists. The scientific concept of the edition suggests the publication of information on current achievements in cardiology, the results of national and international clinical trials. The Journal publishes original articles on the results of clinical trials designed to study the effectiveness and safety of drugs, analysis of clinical practice and its compliance with national and international recommendations, expert s’ opinions on a wide range of cardiology issues, associated conditions and clinical pharmacology. There is a heading “Preventive cardiology and public health” in the Journal to stimulate research interest in this highly demanded area. Memories of the outstanding people in medicine including cardiology, which are of great interest to historians of medicine, are published in "Our Mentors” heading.
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