Heart failure & cardiomyopathies
Urine Chloride Trajectory and Relationship with Diuretic Response in Acute Heart Failure
Main finding · Prediction of poor diuretic response (<100 mL/h in 6 h since start of furosemide infusion)Result — go to the resultOdds ratio 39.0 95% CI 3.8–405.00Authors' conclusion
Urine chloride and sodium are highly interrelated during decongestion of AHF patients. The uCl- (cutoff 72 mmol/L) exhibits better prognostic abilities to identify poor diuretic response than uNa+.
Study context
- Population
- Patients with acute heart failure (AHF) within 36 h of hospitalisation receiving weight-adjusted furosemide
- Participants
- 50 patients
- Exposure
- Urine chloride vs urine sodium after furosemide
- Outcome
- Urine chloride trajectory during intensive diuretic treatment and its prediction of poor diuretic response (<100 mL/h in 6 h)
Methodological detailsFurosemide dose adjusted for body weight (half bolus, half 2 h infusion); hourly post-diuretic urine collection
- Furosemide dose adjusted for body weight (half bolus, half 2 h infusion); hourly post-diuretic urine collection
Main finding
As reported in the abstract
Prediction of poor diuretic response (<100 mL/h in 6 h since start of furosemide infusion)
Odds ratio
39.0
95% CI 3.8–405.00
Urine chloridevs urine sodium after furosemide
OR 39.0 (95% CI 3.8–405.00)
Observational data: associations, not effects.
Further findings
Correlation urine chloride (uCl-) vs uNa+ · 1 h
- Strong linear correlation at each post-furosemide timepoint, strongest at 1 h
- r = 0.87; P < 0.001
- Chronic furosemide users: uCl- = 0.85 * uNa+ + 28.82
- R2 = 0.83, P < 0.001
- Furosemide-naïve: uCl- = 0.72 * uNa+ + 41.55
- R2 = 0.65, P < 0.001
Ion excretion, furosemide-naïve vs chronically exposed
- Furosemide-naïve excreted more uCl- and uNa+ than chronically exposed at all timepoints; uCl- dominance in both
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Urine Chloride Trajectory and Relationship with Diuretic Response in Acute Heart Failure. ESC Heart Fail. Published 22 October 2024. doi:10.
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