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Renal function and natriuresis-guided diuretic therapy - a pre-specified analysis from the PUSH-AHF trial
Kevin Damman1, Iris E Beldhuis1, Peter van der Meer1
1University of Groningen, Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
European Journal of Heart Failure
|May 12, 2024
Summary
Natriuresis-guided diuretic therapy benefits acute heart failure patients, including those with reduced renal function. This approach improves outcomes and renal function effects are temporary and not linked to worse clinical results.
Area of Science:
- Cardiology
- Nephrology
- Clinical Trials
Background:
- Acute heart failure (HF) management often involves diuretics.
- Renal function is a critical factor in HF prognosis and treatment response.
- Previous studies indicated natriuresis-guided therapy improves diuresis in acute HF.
Purpose of the Study:
- To investigate the impact of natriuresis-guided diuretic therapy on patients with acute heart failure, focusing on renal function.
- To analyze the association between baseline renal function, worsening renal function (WRF), and clinical outcomes.
- To compare the efficacy of natriuresis-guided therapy versus standard care in patients with varying degrees of renal function.
Main Methods:
- A pre-specified analysis of the Pragmatic Urinary Sodium-based algoritHm in Acute Heart Failure (PUSH-AHF) trial.
- Patients were randomized to either natriuresis-guided diuretic therapy or standard of care.
- Assessment of serum creatinine, estimated glomerular filtration rate (eGFR), and WRF at fixed timepoints.
Main Results:
- Baseline eGFR did not alter the treatment effect on natriuresis.
- Lower baseline eGFR modified the treatment effect on mortality and HF rehospitalization, with a lower risk in the natriuresis-guided group.
- Natriuresis-guided therapy led to a transient decrease in eGFR, but WRF was not associated with worse outcomes.
Conclusions:
- Natriuresis-guided diuretic treatment is effective in acute heart failure patients regardless of baseline eGFR or WRF.
- The therapy shows benefits even in patients with low eGFR.
- Transient changes in eGFR with natriuresis-guided therapy are not linked to adverse clinical outcomes.
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