Heart failure & cardiomyopathies
Dynamics of Urinary Chloride and Sodium and Their Link to Decongestion in Acute Heart Failure and Preserved Ejection Fraction: NACLOCRo-HF Study
Authors' conclusion
In a cohort of elderly patients hospitalized for AHF, persistently elevated urinary chloride at 72 h of admission was associated with residual congestion.
Study context
- Population
- Elderly patients hospitalised for acute HF with HFpEF, receiving IV furosemide for ≥72 h
- Participants
- 70 patients
- Exposure
- Urinary chloride vs urinary sodium trajectories in relation to residual congestion
- Outcome
- uCl and uNa trajectories and their association with residual congestion (CCS ≥ 2, portal vein pulsatility ≥ 30%, ePVS > 5.5 mL/g)
- Follow-up
- 72 h
Methodological detailssingle-centre, Linear mixed-effects models
- Single-centre
- Linear mixed-effects models
Main finding
As reported in the abstract
| Group | Value | Baseline value | ROC AUC for residual congestion | Optimal cutoff at 72 h |
|---|---|---|---|---|
| Urinary chloride (uCl) | median 94 (IQR 68–116) mmol/L | 94 mmol/L | 0.819 | 61 mmol/L |
| uNa | median 81 (IQR 58–97) mmol/L | 81 mmol/L | 0.790 |
Value
Urinary chloride (uCl)median 94 (IQR 68–116) mmol/L
uNamedian 81 (IQR 58–97) mmol/L
Baseline value
Urinary chloride (uCl)94 mmol/L
uNa81 mmol/L
ROC AUC for residual congestion
Urinary chloride (uCl)0.819
uNa0.790
Optimal cutoff at 72 h
Urinary chloride (uCl)61 mmol/L
uNa— not stated in the abstract
- uCl declined significantly by 48 h
- P = 0.029
- uCl declined significantly by 72 h
- P < 0.001
- Higher uCl at 72 h associated with clinical congestion score (CCS) ≥ 2
- P for interaction = 0.039
- Higher uCl at 72 h associated with portal vein pulsatility ≥ 30%
- P for interaction = 0.018
- Higher uCl at 72 h associated with estimated plasma volume status (ePVS) > 5.5 mL/g
- P for interaction = 0.035
- uNa trajectories differed significantly only across ePVS
- P for interaction = 0.015
Observational data: associations, not effects.
Original publication
Dynamics of Urinary Chloride and Sodium and Their Link to Decongestion in Acute Heart Failure and Preserved Ejection Fraction: NACLOCRo-HF Study. ESC Heart Fail. Published 13 October 2025. doi:10.
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