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Published on: July 3, 2013
Role of spot urinary sodium in outpatients with heart failure
Miguel Lorenzo1, Rafael de la Espriella1, Gema Miñana2
1Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain.
Insights
Lower urinary sodium (UNa+) levels in chronic heart failure (HF) outpatients indicate a higher risk of worsening HF events. This finding supports UNa+ monitoring for better HF management.
Area of Science:
- Cardiology
- Nephrology
- Clinical Medicine
Background:
- Spot urinary sodium (UNa+) monitoring is valuable for acute heart failure (AHF) diuretic response.
- Evidence for UNa+ in chronic heart failure (HF) outpatients is limited.
- Understanding UNa+ role in chronic HF is crucial for patient management.
Purpose of the Study:
- To investigate the association between spot UNa+ levels and risks of mortality and worsening heart failure (WHF) in chronic HF outpatients.
- To evaluate UNa+ as a predictor of adverse events in a real-world chronic HF cohort.
Main Methods:
- An ambispective observational study included 1145 chronic HF outpatients.
- Spot UNa+ was measured 1-5 days before clinic visits.
- Multivariate Cox and negative binomial regressions assessed associations between UNa+ and mortality/WHF events.
Main Results:
- The median UNa+ was 72 mmol/L; 25.6% experienced mortality and 20.3% had WHF events over ~2.6 years.
- Lower baseline UNa+ showed a significant inverse linear association with total WHF events (IRR 1.07) and AHF-hospitalizations (IRR 1.08).
- A borderline association was observed between lower UNa+ and all-cause mortality (HR 1.04).
Conclusions:
- Lower spot urinary sodium levels are linked to increased risk of recurrent worsening heart failure events in chronic HF outpatients.
- Spot UNa+ may serve as a useful biomarker for risk stratification in chronic HF management.
- Further research can explore therapeutic implications of UNa+ monitoring in chronic HF.
Introduction And Objectives:
Spot determination of urinary sodium (UNa+) has emerged as a useful tool for monitoring diuretic response in patients with acute heart failure (AHF). However, the evidence in outpatients is scarce. We aimed to examine the relationship between spot UNa+ levels and the risk of mortality and worsening heart failure (WHF) events in individuals with chronic HF.
Methods:
This observational and ambispective study included 1145 outpatients with chronic HF followed in a single center specialized HF clinic. UNa+ assessment was carried out 1-5 days before each visit. The endpoints of the study were the association between UNa+ and risk of a) long-term death and b) AHF-hospitalization and total WHF events (including AHF-hospitalization, emergency department visits or parenteral loop-diuretic administration in HF clinic), assessed by multivariate Cox and negative binomial regressions.
Results:
The mean±standard deviation of age was 73±11 years, 670 (58.5%) were men, 902 (78.8%) were on stable NYHA class II, and 595 (52%) had LFEF ≥50%. The median (interquartile range) UNa+ was 72 (51-94) mmol/L. Over a median follow-up of 2.63 (1.70-3.36) years, there were 293 (25.6%) deaths and 382 WHF events (244 AHF-admissions) in 233 (20.3%) patients. After multivariate adjustment, baseline UNa+ was inverse and linearly associated with the risk of total WHF (IRR, 1.07; 95%CI, 1.02-1.12; P=.007) and AHF-admissions (IRR, 1.08; 95%CI, 1.02-1.14; P=.012) and borderline associated with all-cause mortality (HR, 1.04; 95%CI, 0.99-1.09; P=.068).
Conclusions:
In outpatients with chronic HF, lower UNa+ was associated with a higher risk of recurrent WHF events.
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