{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:06:26Z","timestamp":1792782386950,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":349,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T00:00:00Z","timestamp":1729555200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Institute of Heart Diseases, Wroclaw Medical University","award":["SUBZ.A460.22.055;IDUB.A46B.24.002"],"award-info":[{"award-number":["SUBZ.A460.22.055;IDUB.A46B.24.002"]}],"id":[{"id":"https:\/\/ror.org\/01qpw1b93","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Sodium excretion is a well-defined marker used to assess diuretic response in acute heart failure (AHF). Despite a strong pathophysiological background, the role of urine chloride excretion has not been described and established yet. We aimed to evaluate chloride trajectory during intensive diuretic treatment in AHF patients and examine its potential role in predicting poor diuretic response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study was conducted on 50 AHF patients. Participants were included within the first 36 h of hospitalization. They received furosemide dose adjusted for body weight (half in bolus, half in 2 h infusion). Post-diuretic hourly urine collection with biochemical analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In general, the concentrations of urine chloride (uCl\u2212) and sodium (uNa+) at the baseline samples exhibited a comparable level (71 \u00b1 39 vs. 70 \u00b1 44 mmol\/L, respectively; P = 0.99), but across all post-furosemide study timepoints, uCl\u2212 remained significantly higher than uNa+ since 1 to 6 h of the study. In this course, both ions (uCl\u2212 and uNa+) reached peak values in 2 h (114 \u00b1 28 vs. 97 \u00b1 34 mmol\/L, respectively; P &amp;lt; 0.01). The pattern of uCl\u2212 dominance over uNa+ concentration was also observed in separate analyses of patients na\u00efve to furosemide and those chronically exposed to furosemide. Regardless of these patterns, na\u00efve to furosemide individuals excreted more ions (both uCl\u2212 and uNa+) than chronically exposed patients at all timepoints. Additionally, a strong, linear correlation between uCl\u2212 and uNa+ was observed in each post-furosemide timepoint (the strongest in 1 h r = 0.87; P &amp;lt; 0.001). Both interdependent ions concentration was almost parallel when analysed in chronic furosemide users and those na\u00efve to furosemide separately [uCl\u2212 = 0.85 * uNa+ + 28.82, P &amp;lt; 0.001, R2 = 0.83 for chronic furosemide users, and uCl\u2212 = 0.72 * uNa+ + 41.55, P &amp;lt; 0.001, R2 = 0.65 for na\u00efves to furosemide (linear regression model)]. Moreover, uCl\u2212 (with cutoff point: 72 mmol\/L) was a satisfactory predictive factor for poor diuretic response (&amp;lt;100 mL\/h in 6 h since the beginning of furosemide infusion) [odds ratio (OR) 95% confidence interval (CI): 39.0 (3.8\u2013405.00)]. It presented those properties also after adjusting for urine creatinine [cutoff point: 0.296 mmol\/mg\u2014OR (95% CI): 81.0 (8.0\u2013816.0)].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Urine chloride and sodium are highly interrelated during decongestion of AHF patients. The uCl\u2212 (cutoff 72 mmol\/L) exhibits better prognostic abilities to identify poor diuretic response than uNa+.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15054","type":"journal-article","created":{"date-parts":[[2024,10,22]],"date-time":"2024-10-22T23:04:33Z","timestamp":1729638273000},"page":"133-141","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Urine Chloride Trajectory and Relationship with Diuretic Response in Acute Heart Failure"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9711-6568","authenticated-orcid":false,"given":"Mateusz","family":"Guzik","sequence":"first","affiliation":[{"name":"Institute of Heart Diseases , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Zymli\u0144ski","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Ponikowski","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Biegus","sequence":"additional","affiliation":[{"name":"Institute of Heart Diseases , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,22]]},"reference":[{"key":"2026012113061592400_ehf215054-bib-0001","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1161\/CIRCRESAHA.121.318172","article-title":"Epidemiology of heart failure","volume":"128","author":"Roger","year":"2021","journal-title":"Circ. Res."},{"key":"2026012113061592400_ehf215054-bib-0002","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s11897-017-0351-y","article-title":"Acute heart failure: definition, classification and epidemiology","volume":"14","author":"Kurmani","year":"2017","journal-title":"Curr. Heart Fail. Rep."},{"key":"2026012113061592400_ehf215054-bib-0003","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1002\/ehf2.13809","article-title":"Assessment of congestion and clinical outcomes in patients with chronic heart failure using shear wave elasticity","volume":"9","author":"Nakayama","year":"2022","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0004","doi-asserted-by":"publisher","first-page":"3358","DOI":"10.1002\/ehf2.14067","article-title":"Differences in extracellular fluid volume between acute heart failure patients with and without high systolic blood pressure","volume":"9","author":"Namba","year":"2022","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0005","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0006","doi-asserted-by":"publisher","first-page":"3667","DOI":"10.1002\/ehf2.14257","article-title":"Heart failure: an update from the last years and a look at the near future","volume":"9","author":"Riccardi","year":"2022","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0007","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1002\/ehf2.14255","article-title":"ACC\/AHA\/HFSA 2022 and ESC 2021 guidelines on heart failure comparison","volume":"10","author":"Behnoush","year":"2023","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0008","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1002\/ejhf.2471","article-title":"Renal effects of guideline-directed medical therapies in heart failure: a consensus document from the Heart Failure Association of the European Society of Cardiology","volume":"24","author":"Mullens","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0009","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1002\/ehf2.14648","article-title":"Changes over time in patient-reported outcomes in patients with heart failure","volume":"11","author":"Jaarsma","year":"2024","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0010","doi-asserted-by":"publisher","first-page":"2249","DOI":"10.1002\/ehf2.13759","article-title":"Characteristics and outcomes of patients admitted for acute heart failure in a single-centre study","volume":"9","author":"Dokoupil","year":"2022","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0011","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1002\/ehf2.14187","article-title":"Association between serum sodium level trajectories and survival in patients with heart failure","volume":"10","author":"Xia","year":"2023","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0012","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1002\/ehf2.14327","article-title":"Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease","volume":"10","author":"Watanabe","year":"2023","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0013","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.1002\/ehf2.14378","article-title":"Renal tubular damage and clinical outcome in heart failure with preserved ejection fraction and chronic kidney disease","volume":"10","author":"Otaki","year":"2023","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0014","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1159\/000525730","article-title":"Serum and urine osmolality as predictors of adequate diuresis in acute decompensated heart failure: a prospective cohort study","volume":"12","author":"Lo","year":"2022","journal-title":"Cardiorenal Med."},{"key":"2026012113061592400_ehf215054-bib-0015","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1002\/ejhf.1428","article-title":"Serial assessment of spot urine sodium predicts effectiveness of decongestion and outcome in patients with acute heart failure","volume":"21","author":"Biegus","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0016","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1080\/ac.70.3.3080630","article-title":"Determinants and impact of the natriuretic response to diuretic therapy in heart failure with reduced ejection fraction and volume overload","volume":"70","author":"Verbrugge","year":"2015","journal-title":"Acta Cardiol."},{"key":"2026012113061592400_ehf215054-bib-0017","doi-asserted-by":"publisher","first-page":"2044","DOI":"10.1002\/ehf2.13927","article-title":"Mechanistic insights into chloride-related heart failure progression according to the plasma volume status","volume":"9","author":"Kataoka","year":"2022","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0018","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1016\/j.jchf.2021.07.006","article-title":"Chloride in heart failure","volume":"9","author":"Zandijk","year":"2021","journal-title":"JACC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0019","doi-asserted-by":"publisher","DOI":"10.3390\/life13030698","article-title":"The prognostic role of spot urinary sodium and chloride in a cohort of hospitalized advanced heart failure patients: a pilot study","volume":"13","author":"Xanthopoulos","year":"2023","journal-title":"Life"},{"key":"2026012113061592400_ehf215054-bib-0020","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/s40119-021-00238-2","article-title":"Chloride in heart failure syndrome: its pathophysiologic role and therapeutic implication","volume":"10","author":"Kataoka","year":"2021","journal-title":"Cardiol. Ther."},{"key":"2026012113061592400_ehf215054-bib-0021","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.1093\/eurheartj\/ehv010","article-title":"The kidney in heart failure: an update","volume":"36","author":"Damman","year":"2015","journal-title":"Eur. Heart J."},{"key":"2026012113061592400_ehf215054-bib-0022","doi-asserted-by":"publisher","first-page":"2135","DOI":"10.1093\/eurheartj\/ehs205","article-title":"The role of the kidney in heart failure","volume":"33","author":"Metra","year":"2012","journal-title":"Eur. Heart J."},{"key":"2026012113061592400_ehf215054-bib-0023","doi-asserted-by":"publisher","first-page":"3237","DOI":"10.1002\/ehf2.14520","article-title":"Incidence, mortality, and predictors of acute kidney injury in patients with heart failure: a systematic review","volume":"10","author":"Ru","year":"2023","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0024","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1002\/ejhf.2852","article-title":"The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure","volume":"25","author":"Biegus","year":"2023","journal-title":"Eur. J. Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0025","doi-asserted-by":"publisher","first-page":"2597","DOI":"10.1002\/ehf2.13372","article-title":"Spot urine sodium in acute heart failure: differences in prognostic value on admission and discharge","volume":"8","author":"Biegus","year":"2021","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0026","doi-asserted-by":"publisher","first-page":"461","DOI":"10.7326\/0003-4819-130-6-199903160-00002","article-title":"A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation","volume":"130","author":"Levey","year":"1999","journal-title":"Ann. Intern. Med."},{"key":"2026012113061592400_ehf215054-bib-0027","doi-asserted-by":"publisher","first-page":"F958","DOI":"10.1152\/ajprenal.00476.2015","article-title":"Everything we always wanted to know about furosemide but were afraid to ask","volume":"310","author":"Huang","year":"2016","journal-title":"American J. Physiol.-Renal Physiol."},{"key":"2026012113061592400_ehf215054-bib-0028","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.mpaic.2018.02.015","article-title":"Renal physiology: acid\u2013base balance","volume":"19","author":"McTavish","year":"2018","journal-title":"Anaesthesia & Intensive Care Med."},{"key":"2026012113061592400_ehf215054-bib-0029","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s10741-015-9482-y","article-title":"Acid\u2013base and electrolyte abnormalities in heart failure: pathophysiology and implications","volume":"20","author":"Urso","year":"2015","journal-title":"Heart Fail. Rev."},{"key":"2026012113061592400_ehf215054-bib-0030","doi-asserted-by":"publisher","first-page":"F374","DOI":"10.1152\/ajprenal.1985.248.3.F374","article-title":"Structural adaptation of the distal convoluted tubule to prolonged furosemide treatment","volume":"248","author":"Kaissling","year":"1985","journal-title":"American J. Physiol. -Renal Physiol."},{"key":"2026012113061592400_ehf215054-bib-0031","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ijcard.2021.10.149","article-title":"Distinct renin\/aldosterone activity profiles correlate with renal function, natriuretic response, decongestive ability and prognosis in acute heart failure","volume":"345","author":"Biegus","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"2026012113061592400_ehf215054-bib-0032","doi-asserted-by":"publisher","first-page":"3536","DOI":"10.1002\/ehf2.13064","article-title":"Elevated plasma endothelin-1 is related to low natriuresis, clinical signs of congestion, and poor outcome in acute heart failure","volume":"7","author":"Zymli\u0144ski","year":"2020","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0033","doi-asserted-by":"publisher","DOI":"10.3390\/biom11111701","article-title":"Differences in the biomarker profile of de novo acute heart failure versus decompensation of chronic heart failure","volume":"11","author":"Nawrocka-Millward","year":"2021","journal-title":"Biomolecules"},{"key":"2026012113061592400_ehf215054-bib-0034","doi-asserted-by":"publisher","first-page":"4077","DOI":"10.1002\/ehf2.14083","article-title":"Neuroendocrine hormone status and diuretic response to atrial natriuretic peptide in patients with acute heart failure","volume":"9","author":"Matsumoto","year":"2022","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0035","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.1002\/ehf2.14313","article-title":"Angiotensin pathways under therapy with empagliflozin in patients with chronic heart failure","volume":"10","author":"Bosch","year":"2023","journal-title":"ESC Heart Fail."},{"key":"2026012113061592400_ehf215054-bib-0036","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1681\/ASN.2009070759","article-title":"Macula Densa sensing and signaling mechanisms of renin release","volume":"21","author":"Peti-Peterdi","year":"2010","journal-title":"J. Am. Soc. Nephrol."},{"key":"2026012113061592400_ehf215054-bib-0037","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1152\/nips.01442.2003","article-title":"Tubuloglomerular feedback and the control of glomerular filtration rate","volume":"18","author":"Vallon","year":"2003","journal-title":"Physiology"},{"key":"2026012113061592400_ehf215054-bib-0038","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1159\/000504223","article-title":"Renal nerve deafferentation attenuates the fall in GFR during intravenous infusion of furosemide in anesthetized rats","volume":"45","author":"Araujo","year":"2020","journal-title":"Kidney Blood Press. Res."},{"key":"2026012113061592400_ehf215054-bib-0039","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-51744-x","article-title":"Spot urine sodium as a marker of urine dilution and decongestive abilities in acute heart failure","volume":"14","author":"Guzik","year":"2024","journal-title":"Sci. Rep."}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/1\/133\/64513134\/eschf_12_1_133.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/1\/133\/64513134\/eschf_12_1_133.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:06:22Z","timestamp":1769018782000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/12\/1\/133\/8261817"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,22]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,10,22]]},"published-print":{"date-parts":[[2025,2,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.15054","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2024,10,22]]},"assertion":[{"value":"2024-04-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}