{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:25:21Z","timestamp":1784118321494,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T00:00:00Z","timestamp":1686096000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with acute heart failure (AHF) require intensification in the diuretic strategy. However, the optimal diuretic strategy remains unclear. In this work, we aimed to evaluate the role of urinary potassium to creatinine ratio (K\/Cr) to predict diuretic and natriuretic response to thiazide or mineralocorticoid receptor antagonists (MRAs) in a cohort of patients with AHF and preserved ejection fraction (AHF\u2010pEF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>Patients with a high urinary K\/Cr ratio will have a better diuretic and natriuretic response with spironolactone versus chlorthalidone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a study of 44 patients with AHF\u2010pEF with suboptimal loop diuretic response. The primary endpoint was the baseline K\/Cr\u00a0associated with natriuretic and diuretic effect of chlorthalidone versus spironolactone at 24\u00a0and 72\u2009h. Mixed linear regression models were used to analyze the endpoints. Estimates were reported as least squares mean\u00a0with their respective 95% confidence interval\u00a0(CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median age of the study population was 85 years (82.5\u221288.5), and 30 (68.2%) were women. The inferential multivariate analysis suggested a greater natriuretic and diuretic effect of chlorthalidone across K\/Cr levels. In the upper category, chlorthalidone translated into a statistically increase in natriuresis at 24\u00a0and 72\u2009h. Chlorthalidone versus spironolactone showed \u2206uNa of 25.7\u2009mmol\/L at 24\u2009h (95%\u00a0CI\u2009=\u2009\u22123.7 to 55.4, <jats:italic>p<\/jats:italic>\u2009=\u2009.098) and \u2206uNa of 24.8\u2009mmol\/L at 72\u2009h (95%\u00a0CI\u2009=\u2009\u22124 to 53.6, <jats:italic>p<\/jats:italic>\u2009=\u2009.0106). The omnibus <jats:italic>p<\/jats:italic> value is .027. Multivariate analyses revealed a significant increase in 72\u2009h\u00a0cumulative diuresis irrespective of K\/Cr status in those on chlorthalidone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with AHF\u2010pEF and suboptimal diuretic response, diuresis and natriuresis are higher with the administration of chlorthalidone over spironolactone. These data don't support the hypothesis that the K\/Cr ratio can help guide the choice of thiazide diuretic versus MRA in AHF\u2010pEF patients on loop diuretic.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.24040","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T05:54:23Z","timestamp":1686203663000},"page":"906-913","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Usefulness of urinary potassium to creatinine ratio to predict diuretic response in patients with acute heart failure and preserved ejection fraction"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0988-0599","authenticated-orcid":false,"given":"Pau","family":"Ll\u00e0cer","sequence":"first","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"},{"name":"Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud Universidad de Alcala\u0301 Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1672-7119","authenticated-orcid":false,"given":"Julio","family":"N\u00fa\u00f1ez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Cl\u00ednico Universitario Universitat de Vale\u0300ncia, INCLIVA Valencia Spain"},{"name":"CIBER Cardiovascular Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Croset","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"},{"name":"Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud Universidad de Alcala\u0301 Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart\u00edn","family":"Fabregate","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ra\u00fal","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genoveva","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Del Hoyo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Campos","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gomis","sequence":"additional","affiliation":[{"name":"Nephrology Department Hospital Universitario Ram\u00f3n y Cajal Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Manzano","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Hospital Universitario Ram\u00f3n y Cajal, IRYCIS Madrid Spain"},{"name":"Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud Universidad de Alcala\u0301 Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11897-015-0273-5"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.06.034"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1369"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(98)00111-9"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000047397"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(75)90041-1"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a014805"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-018-0290-3"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000168356"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.11.023"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.2198"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjacc\/zuac006"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2295"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/edrv-6-1-24"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2013.04.002"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw128"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.24040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T05:52:32Z","timestamp":1692683552000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.24040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,7]]},"references-count":17,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1002\/clc.24040"],"URL":"https:\/\/doi.org\/10.1002\/clc.24040","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,7]]},"assertion":[{"value":"2022-05-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}