{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:33:11Z","timestamp":1793385191677,"version":"4.5.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T00:00:00Z","timestamp":1713312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100018853","name":"Prince Charles Hospital Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100018853","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Spot urinary sodium concentration (UNa) is advocated in guidelines to assess diuretic response and titrate dosage in acute heart failure (AHF). However, no randomized controlled trial data exist to support this approach. We performed a prospective pilot trial to investigate the feasibility of this approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Sixty patients with AHF (n\u00a0=\u00a030 in each arm) were randomly assigned to titration of loop diuretics for the first 48 h of admission according to UNa levels (intervention arm) or based on clinical signs and symptoms of congestion (standard care arm). Diuretic insufficiency was defined as UNa &amp;lt;50\u00a0mmol\/L. Endpoints relating to diuretic efficacy, safety, and AHF outcomes were evaluated. UNa-guided therapy patients experienced less acute kidney injury (20%\u00a0vs. 50%, P\u00a0=\u00a00.01) and a tendency towards less hypokalaemia (serum K+ &amp;lt;3.5\u00a0mmol, 7%\u00a0vs. 27%, P\u00a0=\u00a00.04), with greater weight loss (3.3\u00a0kg vs. 2.1\u00a0kg, P\u00a0=\u00a00.01). They reported a greater reduction in the clinical congestion score (\u22124.7\u00a0vs. \u22122.6, P\u00a0&amp;lt;\u00a00.01) and were more likely to report marked symptom improvement (40%\u00a0vs. 13.3%, P\u00a0=\u00a00.04) at 48 h. There was no difference in the length of hospital stay (median length of stay: 8 days in both groups, P\u00a0=\u00a00.98), 30-day mortality, or readmission rate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>UNa-guided titration of diuretic therapy in AHF is feasible and safer than titration based on clinical signs and symptoms of congestion, with more effective decongestion at 48 h. Further large-scale trials are needed to determine if the superiority of this approach translates into improved patient outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>ACTRN12621000950864<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcae028","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T02:06:05Z","timestamp":1713405965000},"page":"97-104","source":"Crossref","is-referenced-by-count":12,"title":["Spot urinary sodium-guided titration of intravenous diuretic therapy in acute heart failure: a pilot randomized controlled trial"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9699-4892","authenticated-orcid":false,"given":"Maryam","family":"Khorramshahi Bayat","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Prince Charles Hospital , 627 Rode Rd, Brisbane, QLD 4032 ,","place":["Australia"]},{"name":"School of Clinical Medicine, Faculty of Medicine, The University of Queensland , St Lucia, Brisbane, QLD 4072 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wandy","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Prince Charles Hospital , 627 Rode Rd, Brisbane, QLD 4032 ,","place":["Australia"]},{"name":"School of Clinical Medicine, Faculty of Medicine, The University of Queensland , St Lucia, Brisbane, QLD 4072 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Hay","sequence":"additional","affiliation":[{"name":"QIMR Berghofer Medical Research Institute , Brisbane, QLD 4006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"McKenzie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Prince Charles Hospital , 627 Rode Rd, Brisbane, QLD 4032 ,","place":["Australia"]},{"name":"School of Clinical Medicine, Faculty of Medicine, The University of Queensland , St Lucia, Brisbane, QLD 4072 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polash","family":"Adhikari","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Faculty of Medicine, The University of Queensland , St Lucia, Brisbane, QLD 4072 ,","place":["Australia"]},{"name":"Department of Emergency, The Prince Charles Hospital , Brisbane, QLD 4032 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin","family":"Fincher","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Faculty of Medicine, The University of Queensland , St Lucia, Brisbane, QLD 4072 ,","place":["Australia"]},{"name":"Department of Emergency, The Prince Charles Hospital , Brisbane, QLD 4032 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faye","family":"Jordan","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Faculty of Medicine, The University of Queensland , St Lucia, Brisbane, QLD 4072 ,","place":["Australia"]},{"name":"Department of Emergency, The Prince Charles Hospital , Brisbane, QLD 4032 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isuru","family":"Ranasinghe","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Prince Charles Hospital , 627 Rode Rd, Brisbane, QLD 4032 ,","place":["Australia"]},{"name":"School of Clinical Medicine, Faculty of Medicine, The University of Queensland , St Lucia, Brisbane, QLD 4072 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,4,17]]},"reference":[{"key":"2025011608360979300_bib1","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1093\/eurjpc\/zwaa147","article-title":"Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017","volume":"28","author":"Bragazzi","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"2025011608360979300_bib2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.21037\/amj.2020.03.03","article-title":"Global epidemiology and future trends of heart failure","volume":"5","author":"Lippi","year":"2020","journal-title":"AME Med J"},{"key":"2025011608360979300_bib3","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: a comprehensive and updated review of epidemiology","volume":"18","author":"Savarese","year":"2023","journal-title":"Cardiovasc Res"},{"key":"2025011608360979300_bib4","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1186\/s12913-016-1748-0","article-title":"Current and projected burden of heart failure in the Australian adult population: a substantive but still ill-defined major health issue","volume":"16","author":"Chan","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"2025011608360979300_bib5","first-page":"e153","article-title":"Heart disease and stroke statistics\u20142022 update: a report from the American Heart Association","volume-title":"Circulation","author":"Tsao","year":"2022"},{"key":"2025011608360979300_bib6","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/s41572-020-0151-7","article-title":"Acute heart failure","volume":"6","author":"Arrigo","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"2025011608360979300_bib7","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1002\/ejhf.2595","article-title":"Long-term survival and life expectancy following an acute heart failure hospitalization in Australia and New Zealand","volume":"24","author":"Hariharaputhiran","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2025011608360979300_bib8","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1002\/ejhf.2030","article-title":"Frequency, trends and institutional variation in 30-day all-cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand","volume":"23","author":"Labrosciano","year":"2021","journal-title":"Eur J Heart Fail"},{"key":"2025011608360979300_bib9","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1056\/NEJMoa1005419","article-title":"Diuretic strategies in patients with acute decompensated heart failure","volume":"364","author":"Felker","year":"2011","journal-title":"N Engl J Med"},{"key":"2025011608360979300_bib10","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1093\/ehjqcco\/qcac007","article-title":"The association between urinary sodium concentration (UNa) and outcomes of acute heart failure: a systematic review and meta-analysis","volume":"8","author":"Bayat","year":"2022","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2025011608360979300_bib11","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1002\/ejhf.1697","article-title":"Evaluation of kidney function throughout the heart failure trajectory\u2014a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Mullens","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2025011608360979300_bib12","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2025011608360979300_bib13","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1177\/0962280215588241","article-title":"Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable","volume":"25","author":"Whitehead","year":"2016","journal-title":"Stat Methods Med Res"},{"key":"2025011608360979300_bib14","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1093\/eurheartj\/ehs444","article-title":"Clinical course and predictive value of congestion during hospitalisation in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial","volume":"34","author":"Ambrosy","year":"2013","journal-title":"Eur Heart J"},{"key":"2025011608360979300_bib15","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1253\/circj.CJ-19-1128","article-title":"Efficacy of rapid decongestion strategy in patients hospitalized for acute heart failure","volume":"84","author":"Oguri","year":"2020","journal-title":"Circ J"},{"key":"2025011608360979300_bib16","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.cjco.2020.03.012","article-title":"Assessing splanchnic compartment using portal venous doppler and impact of adding it to the EVEREST score for risk assessment in heart failure","volume":"2","author":"Bouabdallaoui","year":"2020","journal-title":"CJC Open"},{"key":"2025011608360979300_bib17","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jchf.2017.09.023","article-title":"Integrative assessment of congestion in heart failure throughout the patient journey","volume":"6","author":"Girerd","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2025011608360979300_bib18","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jmpt.2003.11.003","article-title":"Assessing the clinical significance of change scores recorded on subjective outcome measures","volume":"27","author":"Hurst","year":"2004","journal-title":"J Manipulative Physiol Ther"},{"key":"2025011608360979300_bib19","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/S0735-1097(00)00531-3","article-title":"Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure","volume":"35","author":"Green","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2025011608360979300_bib20","doi-asserted-by":"crossref","first-page":"40","DOI":"10.5492\/wjccm.v1.i2.40","article-title":"Acute kidney injury classification: AKIN and RIFLE criteria in critical patients","volume":"1","author":"Lin","year":"2012","journal-title":"World J Crit Care Med"},{"key":"2025011608360979300_bib21","doi-asserted-by":"crossref","first-page":"4685","DOI":"10.1002\/ehf2.13666","article-title":"Rationale and design of the efficacy of a standardized diuretic protocol in acute heart failure study","volume":"8","author":"Dauw","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2025011608360979300_bib22","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion\u2014a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"21","author":"Mullens","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2025011608360979300_bib23","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.ijcard.2018.01.067","article-title":"Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure","volume":"258","author":"Rubio-Gracia","year":"2018","journal-title":"Int J Cardiol"},{"key":"2025011608360979300_bib24","doi-asserted-by":"crossref","first-page":"e008166","DOI":"10.1161\/CIRCHEARTFAILURE.120.008166","article-title":"Potential role of natriuretic response to furosemide stress test during acute heart failure","volume":"14","author":"Caravaca P\u00e9rez","year":"2021","journal-title":"Circ Heart Fail"},{"key":"2025011608360979300_bib25","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3390\/kidneydial3010005","article-title":"Renal mechanisms of diuretic resistance in congestive heart failure","volume":"3","author":"Lameire","year":"2023","journal-title":"Kidney and Dialysis"},{"key":"2025011608360979300_bib26","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1161\/HYPERTENSIONAHA.120.15205","article-title":"Pathophysiology of diuretic resistance and its implications for the management of chronic heart failure","volume":"76","author":"Wilcox","year":"2020","journal-title":"Hypertension"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcae028\/58258799\/qcae028.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/1\/97\/58258799\/qcae028.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/1\/97\/58258799\/qcae028.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T08:36:23Z","timestamp":1737016583000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/11\/1\/97\/7649360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,17]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,4,17]]},"published-print":{"date-parts":[[2025,1,16]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcae028","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2024,4,17]]}}}