Rafael de la Espriella1, Eduardo Núñez1, Pau Llàcer2, Sergio García-Blas1, Silvia Ventura3, José María Núñez4, Ruth Sánchez5, Lorenzo Fácila6, Juana María Vaquer7, Vicent Bodí1, Enrique Santas1, Gema Miñana1, Anna Mollar1, Gonzalo Núñez1, Francisco J Chorro1, José L Górriz8, Juan Sanchis9, Antoni Bayés-Genis10, Julio Núñez11. 1. Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain. 2. Servicio de Medicina Interna, Hospital de Manises, Manises, Valencia, Spain. 3. Servicio de Medicina Interna, Hospital de La Plana, Villa-Real, Castellón, Spain. 4. Unidad de Cuidados Intensivos, Hospital Universitario del Vinalopó, Elche, Alicante, Spain. 5. Servicio de Medicina Interna, Hospital Virgen de Los Lirios, Alcoy, Alicante, Spain. 6. Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain. 7. Servicio de Bioquímica, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain. 8. Servicio de Nefrología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain. 9. Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. 10. Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Servicio de Cardiología y Unidad de Insuficiencia Cardiaca, Hospital Universitari Germans Trias i Pujol, Departamento de Medicina, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain. 11. Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Fundación Investigación Clínico de Valencia - Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. Electronic address: yulnunez@gmail.com.
Abstract
INTRODUCTION AND OBJECTIVES:Urinary sodium (UNa+) has emerged as a useful biomarker of poor clinical outcomes in acute heart failure (AHF). Here, we sought to evaluate: a) the usefulness of a single early determination of UNa+ for predicting adverse outcomes in patients with AHF and renal dysfunction, and b) whether the change in UNa+ at 24hours (ΔUNa24h) adds any additional prognostic information over baseline values. METHODS: This is a post-hoc analysis of a multicenter, open-label, randomized clinical trial (IMPROVE-HF) (ClinicalTrials.gov NCT02643147) that randomized 160 patients with AHF and renal dysfunction on admission to a) the standard diuretic strategy, or b) acarbohydrate antigen 125-guided diuretic strategy. The primary end point was all-cause mortality and total all-cause readmissions. RESULTS: The mean age was 78±8 years, and the mean glomerular filtration rate was 34.0±8.5mL/min/1.73 m2. The median UNa+ was 90 (65-111) mmol/L. At a median follow-up of 1.73 years [interquartile range, 0.48-2.35], 83 deaths (51.9%) were registered, as well as 263 all-cause readmissions in 110 patients. UNa+ was independently associated with mortality (HR, 0.75; 95%CI, 0.65-0.87; P <.001) and all-cause readmissions (HR, 0.92; 95%CI, 0.88-0.96; P <.001). The prognostic usefulness of the ΔUNa24h varied according to UNa+ at admission (P for interaction <.05). The ΔUNa24h was inversely associated with both end points only in the group with UNa+ ≤ 50 mmol/L. Conversely, no effect was found in the group with UNa+> 50 mmol/L. CONCLUSIONS: In patients with AHF and renal dysfunction, a single early determination of UNa+ ≤ 50 mmol/L identifies patients with a higher risk of all-cause mortality and readmission. The ΔUNa24h adds prognostic information over baseline values only when UNa+ at admission is ≤ 50 mmol/L.
RCT Entities:
INTRODUCTION AND OBJECTIVES: Urinary sodium (UNa+) has emerged as a useful biomarker of poor clinical outcomes in acute heart failure (AHF). Here, we sought to evaluate: a) the usefulness of a single early determination of UNa+ for predicting adverse outcomes in patients with AHF and renal dysfunction, and b) whether the change in UNa+ at 24hours (ΔUNa24h) adds any additional prognostic information over baseline values. METHODS: This is a post-hoc analysis of a multicenter, open-label, randomized clinical trial (IMPROVE-HF) (ClinicalTrials.gov NCT02643147) that randomized 160 patients with AHF and renal dysfunction on admission to a) the standard diuretic strategy, or b) a carbohydrate antigen 125-guided diuretic strategy. The primary end point was all-cause mortality and total all-cause readmissions. RESULTS: The mean age was 78±8 years, and the mean glomerular filtration rate was 34.0±8.5mL/min/1.73 m2. The median UNa+ was 90 (65-111) mmol/L. At a median follow-up of 1.73 years [interquartile range, 0.48-2.35], 83 deaths (51.9%) were registered, as well as 263 all-cause readmissions in 110 patients. UNa+ was independently associated with mortality (HR, 0.75; 95%CI, 0.65-0.87; P <.001) and all-cause readmissions (HR, 0.92; 95%CI, 0.88-0.96; P <.001). The prognostic usefulness of the ΔUNa24h varied according to UNa+ at admission (P for interaction <.05). The ΔUNa24h was inversely associated with both end points only in the group with UNa+ ≤ 50 mmol/L. Conversely, no effect was found in the group with UNa+> 50 mmol/L. CONCLUSIONS: In patients with AHF and renal dysfunction, a single early determination of UNa+ ≤ 50 mmol/L identifies patients with a higher risk of all-cause mortality and readmission. The ΔUNa24h adds prognostic information over baseline values only when UNa+ at admission is ≤ 50 mmol/L.
Authors: Jose Civera; Rafael de la Espriella; Raquel Heredia; Gema Miñana; Enrique Santas; Adriana Conesa; Anna Mollar; Clara Sastre; Ana Martínez; Amparo Villaescusa; Julio Núñez Journal: J Cardiovasc Transl Res Date: 2021-10-12 Impact factor: 3.216