{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:34:19Z","timestamp":1773448459094,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Spanish Society of Internal Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Congestion is an essential issue in patients with heart failure (HF). Standard treatments do not usually achieve decongestion, and various strategies have been proposed to guide treatment, such as determination of natriuresis. After starting treatment with loop diuretics, we postulate that initial natriuresis might help treatment titration, decongestion, and improve prognosis. Methods: It was a prospective and observational study. Patients admitted with the diagnosis of HF decompensation were eligible. An assessment of congestion was performed during the first 48 h. Results: A total of 113 patients were included. A poor diuretic response was observed in 39.8%. After the first 48 h, patients with a greater diuretic response on admission (NaU &gt; 80 mmol\/L) showed fewer pulmonary b lines (12 vs. 15; p = 0.084), a lower IVC diameter (18 mm vs. 22 mm; p = 0.009), and lower IAP figures (11 mmHg vs. 13 mmHg; p = 0.041). Survival analysis tests demonstrated significant differences showing a higher proportion of all-cause mortality (ACM) and HF rehospitalization in the poor-diuretic-response group (log-rank test = 0.020). Conclusions: Up to 40% of the patients presented a poorer diuretic response at baseline, translating into worse outcomes. Patients with an optimal diuretic response showed significantly higher abdominal decongestion at 48 h and a better prognosis regarding ACM and\/or HF rehospitalizations.<\/jats:p>","DOI":"10.3390\/jcm13041053","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T11:30:12Z","timestamp":1707737412000},"page":"1053","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic Impact of Induced Natriuresis in Acute Decompensated Heart Failure and Its Association with Intraabdominal Pressure and Other Congestion Markers: A Multimodal Approach to Congestion Assessment"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8470-9396","authenticated-orcid":false,"given":"Silvia","family":"Crespo-Aznarez","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"},{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amelia","family":"Campos-Saenz de Santamar\u00eda","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"},{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9067-2158","authenticated-orcid":false,"given":"Marta","family":"S\u00e1nchez-Marteles","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"},{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8328-9836","authenticated-orcid":false,"given":"Claudia","family":"Josa-Laorden","sequence":"additional","affiliation":[{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"},{"name":"Internal Medicine Department, Hospital Royo Villanova, 50015 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0438-8834","authenticated-orcid":false,"given":"Fernando","family":"Ruiz-Laiglesia","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"},{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz","family":"Amores-Arriaga","sequence":"additional","affiliation":[{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"},{"name":"Emergency Department, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanesa","family":"Garc\u00e9s-Horna","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"},{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0102-0428","authenticated-orcid":false,"given":"Ruben","family":"Tejel-Puisac","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Deparment, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Angel","family":"Juli\u00e1n-Ans\u00f3n","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Deparment, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6043-4869","authenticated-orcid":false,"given":"Ignacio","family":"Gim\u00e9nez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"},{"name":"School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain"},{"name":"Aragon\u2019s Institute of Health Sciences (IACS), 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2361-9941","authenticated-orcid":false,"given":"Juan Ignacio","family":"P\u00e9rez-Calvo","sequence":"additional","affiliation":[{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"},{"name":"School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4769-7154","authenticated-orcid":false,"given":"Jorge","family":"Rubio-Gracia","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Cl\u00ednico Lozano Blesa, 50009 Zaragoza, Spain"},{"name":"Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain"},{"name":"School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"key":"ref_1","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":"ref_2","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1038\/s41569-020-0379-7","article-title":"Congestion in heart failure: A contemporary look at physiology, diagnosis and treatment","volume":"17","author":"Boorsma","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s10741-011-9248-0","article-title":"Treatment of congestion in heart failure with diuretics and extracorporeal therapies: Effects on symptoms, renal function, and prognosis","volume":"17","author":"Costanzo","year":"2012","journal-title":"Heart Fail. Rev."},{"key":"ref_4","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":"Demissei","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1161\/CIRCHEARTFAILURE.114.001957","article-title":"Relief and recurrence of congestion during and after hospitalization for acute heart failure insights from diuretic optimization strategy evaluation in acute decompensated heart failure (DOSE-AHF) and cardiorenal rescue study in acute decompensated heart failure (CARESS-HF)","volume":"8","author":"Lala","year":"2015","journal-title":"Circ. Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1093\/eurheartj\/ehs444","article-title":"Clinical course and predictive value of congestion during hospitalization 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":"ref_7","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1093\/eurheartj\/ehi631","article-title":"NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: An international pooled analysis of 1256 patients: The International Collaborative of NT-proBNP Study","volume":"27","author":"Januzzi","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.jchf.2016.06.007","article-title":"Carbohydrate Antigen-125-Guided Therapy in Acute Heart Failure: CHANCE-HF: A Randomized Study","volume":"4","author":"Bosch","year":"2016","journal-title":"JACC Heart Fail."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13089-017-0062-3","article-title":"Serial lung and IVC ultrasound in the assessment of congestive heart failure","volume":"9","author":"Spevack","year":"2017","journal-title":"Crit Ultrasound J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"943633","DOI":"10.3389\/fcvm.2022.943633","article-title":"Lung ultrasound-guided treatment for heart failure: An updated meta-analysis and trial sequential analysis","volume":"9","author":"Li","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.cardfail.2018.01.009","article-title":"Spot Urine Sodium as Triage for Effective Diuretic Infusion in an Ambulatory Heart Failure Unit","volume":"24","author":"Brinkley","year":"2018","journal-title":"J. Card. Fail."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.ahj.2018.01.013","article-title":"First spot urine sodium after initial diuretic identifies patients at high risk for adverse outcome after heart failure hospitalization","volume":"203","author":"Luk","year":"2018","journal-title":"Am. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1161\/CIRCHEARTFAILURE.113.000895","article-title":"Loop diuretic efficiency: A metric of diuretic responsiveness with prognostic importance in acute decompensated heart failure","volume":"7","author":"Testani","year":"2014","journal-title":"Circ. Heart Fail."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.jacc.2020.12.022","article-title":"Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure","volume":"77","author":"Rao","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1002\/ejhf.1753","article-title":"Clinical importance of urinary sodium excretion in acute heart failure","volume":"22","author":"Damman","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jchf.2019.01.007","article-title":"Natriuretic Response Is Highly Variable and Associated With 6-Month Survival: Insights From the ROSE-AHF Trial","volume":"7","author":"Hodson","year":"2019","journal-title":"JACC Heart Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/ejhf.2053","article-title":"Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high-risk acute heart failure patients","volume":"23","author":"Biegus","year":"2021","journal-title":"Eur. J. Heart Fail."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1002\/ejhf.2385","article-title":"Natriuresis-guided therapy in acute heart failure: Rationale and design of the Pragmatic Urinary Sodium-based treatment algorithm in Acute Heart Failure (PUSH-AHF) trial","volume":"24","author":"Beldhuis","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1038\/s41591-023-02532-z","article-title":"Natriuresis-guided diuretic therapy in acute heart failure: A pragmatic randomized trial","volume":"29","author":"Beldhuis","year":"2023","journal-title":"Nat. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"825","DOI":"10.7326\/0003-4819-158-11-201306040-00007","article-title":"Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline","volume":"158","author":"Stevens","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1692","DOI":"10.1016\/j.jcmg.2018.06.023","article-title":"Lung Ultrasound for the Cardiologist","volume":"11","author":"Picano","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1378\/chest.07-2800","article-title":"Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol","volume":"134","author":"Lichtenstein","year":"2008","journal-title":"Chest J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1002\/jum.15849","article-title":"Rapid 8-Zone Lung Ultrasound Protocol is Comparable to a Full 12-Zone Protocol for Outcome Prediction in Hospitalized COVID-19 Patients","volume":"41","author":"Preisler","year":"2022","journal-title":"J. Ultrasound Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","article-title":"Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography","volume":"23","author":"Rudski","year":"2010","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"403","DOI":"10.20452\/pamw.4290","article-title":"Validation of transurethral intra abdominal pressure measurement in acute heart failure","volume":"128","author":"Biegus","year":"2018","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1016\/j.jacc.2023.03.400","article-title":"Natriuretic Response to Acetazolamide in Patients With Acute Heart Failure and Volume Overload","volume":"81","author":"Verbrugge","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.4103\/sja.SJA_543_18","article-title":"The STROBE guidelines","volume":"13","author":"Cuschieri","year":"2019","journal-title":"Saudi J. Anaesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1002\/ejhf.1604","article-title":"Lung ultrasound-guided treatment in ambulatory patients with heart failure: A randomized controlled clinical trial (LUS-HF study)","volume":"21","author":"Maestro","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1056\/NEJMoa2203094","article-title":"Acetazolamide in Acute Decompensated Heart Failure with Volume Overload","volume":"387","author":"Mullens","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","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":"ref_31","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.jacc.2013.04.070","article-title":"Abdominal contributions to cardiorenal dysfunction in congestive heart failure","volume":"62","author":"Verbrugge","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jacc.2007.09.043","article-title":"Elevated Intra-Abdominal Pressure in Acute Decompensated Heart Failure. A Potential Contributor to Worsening Renal Function?","volume":"51","author":"Mullens","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1002\/ejhf.1478","article-title":"Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance","volume":"21","author":"Verbrugge","year":"2019","journal-title":"Eur. J. Heart Fail."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"887734","DOI":"10.3389\/fphys.2022.887734","article-title":"Role of Early Assessment of Diuresis and Natriuresis in Detecting In-Hospital Diuretic Resistance in Acute Heart Failure","volume":"13","author":"Martiarena","year":"2022","journal-title":"Front. Physiol."},{"key":"ref_35","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":"ref_36","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/eurheartj\/ehac689","article-title":"Combining loop with thiazide diuretics for decompensated heart failure: The CLOROTIC trial","volume":"44","author":"Casado","year":"2023","journal-title":"Eur. Heart J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/4\/1053\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:59:03Z","timestamp":1760104743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/4\/1053"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,12]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["jcm13041053"],"URL":"https:\/\/doi.org\/10.3390\/jcm13041053","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,12]]}}}