{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:05:40Z","timestamp":1792782340694,"version":"4.5.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,3,31]],"date-time":"2024-03-31T00:00:00Z","timestamp":1711843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2024,3,31]],"date-time":"2024-03-31T00:00:00Z","timestamp":1711843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Sequana Medical","id":[{"id":"https:\/\/ror.org\/00jcmjy20","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Loop diuretics may exacerbate cardiorenal syndrome (CRS) in heart failure (HF). Direct sodium removal (DSR) using the peritoneal membrane, in conjunction with complete diuretic withdrawal, may improve CRS and diuretic resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients with HF requiring high-dose loop diuretics were enrolled in two prospective, single-arm studies: RED DESERT (n\u2009=\u20098 euvolaemic patients), and SAHARA (n\u2009=\u200910 hypervolaemic patients). Loop diuretics were withdrawn, and serial DSR was utilized to achieve and maintain euvolaemia. At baseline, participants required a median 240\u2009mg (interquartile range [IQR] 200\u2013400) oral furosemide equivalents\/day, which was withdrawn in all participants during DSR (median time of DSR 4\u2009weeks [IQR 4\u20136]). Diuretic response (queried by formal 40\u2009mg intravenous furosemide challenge and 6\u2009h urine sodium quantification) increased substantially from baseline (81\u2009\u00b1\u200937\u2009mmol) to end of DSR (223\u2009\u00b1\u200971\u2009mmol, p\u2009&amp;lt;\u20090.001). Median time to re-initiate diuretics was 87\u2009days, and the median re-initiation dose was 8% (IQR 6\u201310%) of baseline. At 1\u2009year, diuretic dose remained substantially below baseline (30 [IQR 7.5\u201340] mg furosemide equivalents\/day). Multiple dimensions of kidney function such as filtration, uraemic toxin excretion, kidney injury, and electrolyte handling improved (p\u2009&amp;lt;\u20090.05 for all). HF-related biomarkers including N-terminal pro-B-type natriuretic peptide, carbohydrate antigen-125, soluble ST2, interleukin-6, and growth differentiation factor-15 (p\u2009&amp;lt;\u20090.003 for all) also improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with HF and diuretic resistance, serial DSR therapy with loop diuretic withdrawal was feasible and associated with substantial and persistent improvement in diuretic resistance and several cardiorenal parameters. If replicated in randomized controlled studies, DSR may represent a novel therapy for diuretic resistance and CRS.<\/jats:p>\n                    <jats:p>Clinical Trial Registration: RED DESERT (NCT04116034), SAHARA (NCT04882358).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3196","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:39:35Z","timestamp":1711931975000},"page":"1215-1230","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Serial Direct Sodium Removal in Patients with Heart Failure and Diuretic Resistance"],"prefix":"10.1093","volume":"26","author":[{"given":"Veena S.","family":"Rao","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan B.","family":"Ivey-Miranda","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]},{"name":"Hospital de Cardiologia, Instituto Mexicano del Seguro Social , Mexico City ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary L.","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Lipscomb University College of Pharmacy , Nashville, TN ,","place":["USA"]},{"name":"Department of Medicine, Vanderbilt University School of Medicine , Nashville, TN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julieta","family":"Moreno-Villagomez","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]},{"name":"Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico , Mexico City ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Ramos-Mastache","sequence":"additional","affiliation":[{"name":"Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico , Mexico City ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Neville","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Balkcom","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Division of Comparative Medicine, Department of Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavanya","family":"Bellumkonda","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar","family":"Bigvava","sequence":"additional","affiliation":[{"name":"Tbilisi Heart and Vascular Clinic , Tbilisi ,","place":["Georgia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamaz","family":"Shaburishvili","sequence":"additional","affiliation":[{"name":"Tbilisi Heart and Vascular Clinic , Tbilisi ,","place":["Georgia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jozef","family":"Bartunek","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, OLV Hospital , Aalst ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. 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