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Early urine electrolyte patterns in patients with acute heart failure

ESC Heart Failure, 2019-02, Vol.6 (1), p.80-88 [Peer Reviewed Journal]

2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. ;2019. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;ISSN: 2055-5822 ;EISSN: 2055-5822 ;DOI: 10.1002/ehf2.12368 ;PMID: 30295437

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Title:
Early urine electrolyte patterns in patients with acute heart failure
Author: Collins, Sean P. ; Jenkins, Cathy A. ; Baughman, Adrienne ; Miller, Karen F. ; Storrow, Alan B. ; Han, Jin H. ; Brown, Nancy J. ; Liu, Dandan ; Luther, James M. ; McNaughton, Candace D. ; Self, Wesley H. ; Peng, Dungeng ; Testani, Jeffrey M. ; Lindenfeld, JoAnn
Subjects: Acute Disease ; Acute heart failure ; Aged ; Biomarkers - urine ; Disease Progression ; Diuretic resistance ; Diuretics ; Diuretics - therapeutic use ; Electrolytes ; Emergency department ; Female ; Follow-Up Studies ; Heart failure ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Heart Failure - urine ; Humans ; Male ; Medical records ; Middle Aged ; Original ; Original s ; Patients ; Pilot Projects ; Prognosis ; Prospective Studies ; Sodium ; Sodium - urine ; Stroke Volume - physiology ; Urine ; Urine electrolytes ; Worsening heart failure
Is Part Of: ESC Heart Failure, 2019-02, Vol.6 (1), p.80-88
Description: Aims We conducted a prospective study of emergency department (ED) patients with acute heart failure (AHF) to determine if worsening HF (WHF) could be predicted based on urinary electrolytes during the first 1–2 h of ED care. Loop diuretics are standard therapy for AHF patients. A subset of patients hospitalized for AHF will develop a blunted natriuretic response to loop diuretics, termed diuretic resistance, which often leads to WHF. Early detection of diuretic resistance could facilitate escalation of therapy and prevention of WHF. Methods and results Patients were eligible if they had an ED AHF diagnosis, had not yet received intravenous diuretics, had a systolic blood pressure > 90 mmHg, and were not on dialysis. Urine electrolytes and urine output were collected at 1, 2, 4, and 6 h after diuretic administration. Worsening HF was defined as clinically persistent or WHF requiring escalation of diuretics or administration of intravenous vasoactives after the ED stay. Of the 61 patients who qualified in this pilot study, there were 10 (16.3%) patients who fulfilled our definition of WHF. At 1 h after diuretic administration, patients who developed WHF were more likely to have low urinary sodium (9.5 vs. 43.0 mmol; P < 0.001) and decreased urine sodium concentration (48 vs. 80 mmol/L; P = 0.004) than patients without WHF. All patients with WHF had a total urine sodium of <35.4 mmol at 1 h (100% sensitivity and 60% specificity). Conclusions One hour after diuretic administration, a urine sodium excretion of <35.4 mmol was highly suggestive of the development of WHF. These relationships require further testing to determine if early intervention with alternative agents can prevent WHF.
Publisher: England: John Wiley & Sons, Inc
Language: English
Identifier: ISSN: 2055-5822
EISSN: 2055-5822
DOI: 10.1002/ehf2.12368
PMID: 30295437
Source: MEDLINE
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Early urine electrolyte patterns in patients with acute heart failure

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