Heart failure & cardiomyopathiesCross-sectional study
Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
- nationwide cross-sectional electronic survey
Authors' conclusion
While uNa⁺ monitoring is valued by clinicians, its use in AHF in Spain remains inconsistent across specialties. Addressing implementation barriers through education, protocols, and decision-support tools is critical to a broader adoption of uNa⁺ guided therapy in routine care.
Study context
- Population
- Clinicians from cardiology, internal medicine, emergency medicine, and nephrology managing acute heart failure (AHF) in Spainphysicians responded · cardiology 138 (33%) · internal medicine 159 (39%) · emergency medicine 78 (19%) · nephrology 38 (9%)
- Participants
- 413 clinicians
- Exposure
- cardiology vs internal medicine vs emergency medicine vs nephrology
- cardiologyn = 138
- internal medicinen = 159
- emergency medicinen = 78
- nephrologyn = 38
Main finding
As reported in the abstract
Measuring uNa+ during AHF hospitalization
Overall, reported measuring uNa+ during AHF hospitalization
70%
Routinely
18%
Observational data: associations, not effects.
Further findings
| Outcome | cardiology | internal medicine | emergency medicine | nephrology |
|---|---|---|---|---|
| Usage by nephrologists · highest usage | ||||
| inpatient | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | 90% |
| outpatient | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | 61% |
Outpatient application
- Outpatient application
- 32%
Cut-off to define diuretic resistance
- Most frequent cut-off
- <50 mmol/l
Therapeutic strategies by specialty
- Loop diuretic escalation more frequent in cardiology and emergency medicine; thiazides preferred in internal medicine and nephrology
Perceived clinical usefulness of uNa⁺ monitoring
- Considered uNa⁺ monitoring clinically useful
- 78%
Barriers
- Lack of standardized protocols, limited training, therapeutic inertia, and logistical constraints
Original publication
Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey. ESC Heart Fail. Published 13 January 2026. doi:10.1093/eschf/xvag006
Summarised from the published abstract; every number is checked against it