Renal function and natriuresis‐guided diuretic therapy – a pre‐specified analysis from the PUSH‐AHF trial

Aim In a randomized controlled trial, we recently showed that a natriuresis‐guided diuretic approach improved natriuresis and diuresis in patients with acute heart failure (HF). In this pre‐specified analysis, we investigated the association between (worsening) renal function, outcomes and the effec...

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Bibliographic Details
Published in:European journal of heart failure 2024-06, Vol.26 (6), p.1347-1357
Main Authors: Damman, Kevin, Beldhuis, Iris E., Meer, Peter, Krikken, Jan A., Coster, Jenifer E., Nieuwland, Wybe, Veldhuisen, Dirk J., Voors, Adriaan A., Maaten, Jozine M.
Format: Article
Language:English
Subjects:
Acute Disease
Acute heart failure
Aged
Creatinine - blood
Diuretics - administration & dosage
Diuretics - therapeutic use
Female
Glomerular Filtration Rate - drug effects
Glomerular Filtration Rate - physiology
Heart Failure - drug therapy
Heart Failure - physiopathology
Humans
Male
Middle Aged
Natriuresis
Natriuresis - drug effects
Sodium Potassium Chloride Symporter Inhibitors - administration & dosage
Sodium Potassium Chloride Symporter Inhibitors - therapeutic use
Treatment Outcome
Worsening renal function
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Summary:Aim In a randomized controlled trial, we recently showed that a natriuresis‐guided diuretic approach improved natriuresis and diuresis in patients with acute heart failure (HF). In this pre‐specified analysis, we investigated the association between (worsening) renal function, outcomes and the effect of intensive natriuresis‐guided loop diuretic therapy as compared with standard of care. Methods and results The Pragmatic Urinary Sodium‐based algoritHm in Acute Heart Failure (PUSH‐AHF) trial randomized patients to natriuresis‐guided diuretic therapy or standard of care. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed at fixed timepoints, and worsening renal function (WRF) was assessed at 72 h. The primary outcome was the interaction between randomized treatment allocation, baseline eGFR and the dual primary outcome of PUSH‐AHF: total natriuresis at 24 h and time to all‐cause mortality or HF rehospitalization at 180 days. In 309 patients, median baseline eGFR was 53 (35–73) ml/min/1.73 m2, and 58% had eGFR
ISSN:1388-9842
1879-0844
1879-0844
DOI:10.1002/ejhf.3228