Heart failure & cardiomyopathiesMeta-analysis
Serial Direct Sodium Removal in Patients with Heart Failure and Diuretic Resistance
- Pooled analysis of two prospective single-arm studies
Authors' conclusion
In patients with HF and diuretic resistance, serial DSR therapy with loop diuretic withdrawal was feasible and associated with substantial and persistent improvement in diuretic resistance and several cardiorenal parameters.
Study context
- Population
- Patients with heart failure (HF) requiring high-dose loop diuretics (diuretic resistance)
- Participants
- 8 vs 10
- Comparison
- Serial direct sodium removal (DSR) with loop diuretic withdrawal, end of DSR vs baseline
- RED DESERTn = 8
- SAHARAn = 10
Pooled result
As reported in the abstract
Diuretic response (6 h urine sodium after 40 mg IV furosemide challenge) · End of DSR vs baseline
P < 0.001
Further pooled results
Loop diuretic dose and re-initiation
- Baseline oral furosemide equivalents/day, median (IQR 200-400)
- 240 mg
- Median time of DSR (IQR 4-6)
- 4 weeks
- Median time to re-initiate diuretics
- 87 days
- Median re-initiation dose, % of baseline (IQR 6-10%)
- 8%
- Diuretic dose at 1 year, furosemide equivalents/day (IQR 7.5-40)
- 30 mg
Kidney function (filtration, uraemic toxin excretion, kidney injury, electrolyte handling)
- Improved
- P < 0.05 for all
HF biomarkers (NT-proBNP, CA-125, soluble ST2, IL-6, GDF-15)
- Improved
- P < 0.003 for all
Original publication
Serial Direct Sodium Removal in Patients with Heart Failure and Diuretic Resistance. Eur J Heart Fail. Published 31 March 2024. doi:10.1002/ejhf.3196
Summarised from the published abstract; every number is checked against it