Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients with Heart Failure

Jeffrey M. Testani, Jennifer S. Hanberg, Susan Cheng, Veena Rao, Chukwuma Onyebeke, Olga Laur, Alexander Kula, Michael Chen, F. Perry Wilson, Andrew Darlington, Lavanya Bellumkonda, Daniel Jacoby, W. H.Wilson Tang, Chirag Parikh

Research output: Contribution to journalArticle

Abstract

Removal of excess sodium and fluid is a primary therapeutic objective in acute decompensated heart failure and commonly monitored with fluid balance and weight loss. However, these parameters are frequently inaccurate or not collected and require a delay of several hours after diuretic administration before they are available. Accessible tools for rapid and accurate prediction of diuretic response are needed. Methods and Results-Based on well-established renal physiological principles, an equation was derived to predict net sodium output using a spot urine sample obtained 1 or 2 hours after loop diuretic administration. This equation was then prospectively validated in 50 acute decompensated heart failure patients using meticulously obtained timed 6-hour urine collections to quantify loop diuretic-induced cumulative sodium output. Poor natriuretic response was defined as a cumulative sodium output of <50 mmol, a threshold that would result in a positive sodium balance with twice-daily diuretic dosing. Following a median dose of 3 mg (2-4 mg) of intravenous bumetanide, 40% of the population had a poor natriuretic response. The correlation between measured and predicted sodium output was excellent (r=0.91; P<0.0001). Poor natriuretic response could be accurately predicted with the sodium prediction equation (area under the curve =0.95, 95% confidence interval 0.89-1.0; P<0.0001). Clinically recorded net fluid output had a weaker correlation (r=0.66; P<0.001) and lesser ability to predict poor natriuretic response (area under the curve =0.76, 95% confidence interval 0.63-0.89; P=0.002). Conclusions-In patients being treated for acute decompensated heart failure, poor natriuretic response can be predicted soon after diuretic administration with excellent accuracy using a spot urine sample.

Original languageEnglish (US)
JournalCirculation: Heart Failure
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Sodium Potassium Chloride Symporter Inhibitors
Heart Failure
Sodium
Diuretics
Area Under Curve
Urine
Confidence Intervals
Bumetanide
Urine Specimen Collection
Water-Electrolyte Balance
Weight Loss
Kidney

Keywords

  • Diuretic resistance
  • diuretics
  • heart failure
  • poor natriuretic response
  • sodium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients with Heart Failure. / Testani, Jeffrey M.; Hanberg, Jennifer S.; Cheng, Susan; Rao, Veena; Onyebeke, Chukwuma; Laur, Olga; Kula, Alexander; Chen, Michael; Wilson, F. Perry; Darlington, Andrew; Bellumkonda, Lavanya; Jacoby, Daniel; Tang, W. H.Wilson; Parikh, Chirag.

In: Circulation: Heart Failure, Vol. 9, No. 1, 01.01.2016.

Research output: Contribution to journalArticle

Testani, JM, Hanberg, JS, Cheng, S, Rao, V, Onyebeke, C, Laur, O, Kula, A, Chen, M, Wilson, FP, Darlington, A, Bellumkonda, L, Jacoby, D, Tang, WHW & Parikh, C 2016, 'Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients with Heart Failure', Circulation: Heart Failure, vol. 9, no. 1. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002370
Testani, Jeffrey M. ; Hanberg, Jennifer S. ; Cheng, Susan ; Rao, Veena ; Onyebeke, Chukwuma ; Laur, Olga ; Kula, Alexander ; Chen, Michael ; Wilson, F. Perry ; Darlington, Andrew ; Bellumkonda, Lavanya ; Jacoby, Daniel ; Tang, W. H.Wilson ; Parikh, Chirag. / Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients with Heart Failure. In: Circulation: Heart Failure. 2016 ; Vol. 9, No. 1.
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AU - Testani, Jeffrey M.

AU - Hanberg, Jennifer S.

AU - Cheng, Susan

AU - Rao, Veena

AU - Onyebeke, Chukwuma

AU - Laur, Olga

AU - Kula, Alexander

AU - Chen, Michael

AU - Wilson, F. Perry

AU - Darlington, Andrew

AU - Bellumkonda, Lavanya

AU - Jacoby, Daniel

AU - Tang, W. H.Wilson

AU - Parikh, Chirag

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AB - Removal of excess sodium and fluid is a primary therapeutic objective in acute decompensated heart failure and commonly monitored with fluid balance and weight loss. However, these parameters are frequently inaccurate or not collected and require a delay of several hours after diuretic administration before they are available. Accessible tools for rapid and accurate prediction of diuretic response are needed. Methods and Results-Based on well-established renal physiological principles, an equation was derived to predict net sodium output using a spot urine sample obtained 1 or 2 hours after loop diuretic administration. This equation was then prospectively validated in 50 acute decompensated heart failure patients using meticulously obtained timed 6-hour urine collections to quantify loop diuretic-induced cumulative sodium output. Poor natriuretic response was defined as a cumulative sodium output of <50 mmol, a threshold that would result in a positive sodium balance with twice-daily diuretic dosing. Following a median dose of 3 mg (2-4 mg) of intravenous bumetanide, 40% of the population had a poor natriuretic response. The correlation between measured and predicted sodium output was excellent (r=0.91; P<0.0001). Poor natriuretic response could be accurately predicted with the sodium prediction equation (area under the curve =0.95, 95% confidence interval 0.89-1.0; P<0.0001). Clinically recorded net fluid output had a weaker correlation (r=0.66; P<0.001) and lesser ability to predict poor natriuretic response (area under the curve =0.76, 95% confidence interval 0.63-0.89; P=0.002). Conclusions-In patients being treated for acute decompensated heart failure, poor natriuretic response can be predicted soon after diuretic administration with excellent accuracy using a spot urine sample.

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