Natriuresis-guided decongestion in acute decompensated heart failure: A systematic review and meta-analysis

Urinary sodium evaluation is promising to guide decongestion in acute decompensated heart failure (ADHF). We aim to assess the efficacy and safety of natriuresis-guided diuretic protocols for ADHF decongestion.

This was a systematic review and meta-analysis synthesizing evidence from randomized controlled trials and non-randomized studies obtained from PubMed, CENTRAL, Scopus, and WOS until August 2024. We report dichotomous outcomes using risk ratio and continuous outcomes using mean difference (MD), with a 95 % confidence interval (CI).

We included four studies with 831 patients. Natriuresis-guided protocols significantly increased natriuresis after 24 h [MD: 86.71 mmol, 95 % CI (49.95, 123.46), p < 0.01], natriuresis after 48 h [MD: 137.57 mmol, 95 % CI (68.58, 206.56), p < 0.01], diuresis after 24 h [MD: 0.76 L, 95 % CI (0.48, 1.05), p < 0.01], diuresis after 48 h [MD: 1.11 L, 95 % CI (0.57, 1.65), p < 0.01], weight loss after 48 h [MD: -0.45, 95 % CI (-0.79, -0.10), p = 0.01], and significantly reduced the length of stay [MD: -0.93 day, 95 % CI (-1.45, -0.40), p < 0.01] compared with the standard of care. However, both groups had no difference in congestion score change (p = 0.12) and all-cause mortality/HF re-hospitalization (p = 0.8).

Natriuresis-guided decongestion in ADHF resulted in significantly increased natriuresis, diuresis, weight loss, and shorter length of hospitalization. However, this did not reflect significant clinical benefits, with no significant effect on mortality or HF re-hospitalization.