Heart failure & cardiomyopathies
Urinary biomarker thresholds to detect diuretic resistance and insufficient diuretic response in acute heart failure
Authors' conclusion
In AHF, data-derived post-diuretic uNa+ thresholds of <60 mmol/L and <90 mmol/L identify diuretic resistance and insufficient diuretic response, respectively.
Study context
- Population
- Patients with acute HF; spot urinary biomarkers 2h after loop diureticderivation 336, validation 141
- Comparison
- Post-diuretic spot urine sodium thresholds for poor diuretic response
- Outcome
- Diuretic resistance (urine output <500 mL/6 h) and insufficient diuretic response (<1000 mL/6 h)
Methodological detailsprospective, derivation-validation
- Prospective
- Derivation-validation
Performance
As reported in the abstract
Derivation cohort
| Strategy | AUC (diuretic resistance) | AUC (insufficient response) | Sensitivity (diuretic resistance) | Sensitivity (insufficient response) | Specificity (diuretic resistance) | Specificity (insufficient response) |
|---|---|---|---|---|---|---|
| uNa+ <60 mmol/L | 0.93 (95%CI: 0.90-0.97) | Not reported in the abstract | 0.80 (95%CI: 0.65 −0.90) | Not reported in the abstract | 0.94 (95%CI: 0.90-0.96) | Not reported in the abstract |
| uNa+ <90 mmol/L | Not reported in the abstract | 0.86 (95%CI: 0.83-0.93) | Not reported in the abstract | 0.80 (95%CI: 0.69-0.86) | Not reported in the abstract | 0.84 (95%CI: 0.787-0.878) |
AUC (diuretic resistance)
uNa+ <60 mmol/L0.93 (95%CI: 0.90-0.97)
uNa+ <90 mmol/LNot reported in the abstract
AUC (insufficient response)
uNa+ <60 mmol/LNot reported in the abstract
uNa+ <90 mmol/L0.86 (95%CI: 0.83-0.93)
Sensitivity (diuretic resistance)
uNa+ <60 mmol/L0.80 (95%CI: 0.65 −0.90)
uNa+ <90 mmol/LNot reported in the abstract
Sensitivity (insufficient response)
uNa+ <60 mmol/LNot reported in the abstract
uNa+ <90 mmol/L0.80 (95%CI: 0.69-0.86)
Specificity (diuretic resistance)
uNa+ <60 mmol/L0.94 (95%CI: 0.90-0.96)
uNa+ <90 mmol/LNot reported in the abstract
Specificity (insufficient response)
uNa+ <60 mmol/LNot reported in the abstract
uNa+ <90 mmol/L0.84 (95%CI: 0.787-0.878)
Further findings
| Outcome | uNa+ <60 mmol/L | uNa+ <90 mmol/L | uNa+ <50 mmol/L | |
|---|---|---|---|---|
| Validation cohort, diuretic resistance | ||||
| Sensitivity | 0.87 (95%CI: 062 −0.98) | Not reported in the abstract | 0.73 (95%CI: 0.48- 0.89) | uNa+ <90 mmol/L: not reported in the abstract |
| Specificity | 0.94 (95%CI: 0.89 −0.97) | Not reported in the abstract | 0.97 (95%CI: 0.92-0.99) | uNa+ <90 mmol/L: not reported in the abstract |
| Validation cohort, insufficient diuretic response | ||||
| Sensitivity | Not reported in the abstract | 0.86 (95%CI: 0.71-0.94) | Not reported in the abstract | uNa+ <60 mmol/L, uNa+ <50 mmol/L: not reported in the abstract |
| Specificity | Not reported in the abstract | 0.83 (95%CI: 0.75 −0.89) | Not reported in the abstract | uNa+ <60 mmol/L, uNa+ <50 mmol/L: not reported in the abstract |
Validation cohort, insufficient diuretic response
- uNa+ <90 mmol/L had higher sensitivity than lower thresholds
Original publication
Urinary biomarker thresholds to detect diuretic resistance and insufficient diuretic response in acute heart failure. Eur J Heart Fail. Published 16 July 2026. doi:10.
Summarised from the published abstract; every number is checked against it