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Related Experiment Video

Updated: Jul 6, 2025

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

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Published on: May 26, 2022

Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study.

Jeroen Dauw^1,2, Kristina Charaya³, Małgorzata Lelonek⁴

¹Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.).

Circulation. Heart Failure

|January 5, 2024

Summary

A standardized diuretic protocol using urinary sodium in acute heart failure significantly increased natriuresis and diuresis. This approach proved feasible, safe, and reduced hospital length of stay.

Keywords:

diuretics heart failure length of stay natriuresis sodium

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Published on: July 28, 2018

Area of Science:

Cardiology
Nephrology
Pharmacology

Background:

Urinary sodium guidance for diuretics in acute heart failure is recommended but lacks robust data.
The ENACT-HF study aimed to address this gap by investigating a standardized natriuresis-guided diuretic protocol.

Purpose of the Study:

To assess the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in acute heart failure patients with volume overload.
To compare this protocol against the standard of care in terms of natriuresis, diuresis, and clinical outcomes.

Main Methods:

An international, multicenter, open-label, pragmatic study comparing a standardized diuretic protocol with standard care.
The protocol utilized urinary sodium to guide diuretic therapy.
Primary endpoint: natriuresis after 1 day. Secondary endpoints: cumulative natriuresis/diuresis, length of stay, in-hospital mortality.

Main Results:

The standardized protocol arm showed significantly higher natriuresis at day 1 (1.64 ratio, P<0.001) and day 2 (1.52 ratio, P<0.001).
Greater diuresis (1.33 ratio, P<0.001) and a shorter length of stay (0.87 ratio, P=0.036) were observed in the protocol arm.
In-hospital mortality was similar between groups (1.4% vs 2.0%, P=0.852).

Conclusions:

A standardized natriuresis-guided diuretic protocol is feasible and safe for managing acute heart failure.
This protocol effectively enhances decongestion, leading to increased natriuresis and diuresis.
The protocol also demonstrated a significant reduction in hospital length of stay.