Objective: In acute heart failure (AHF), early assessment of spot urinary sodium (U_Na) has emerged as a useful biomarker for risk stratification and monitoring. The objective of this study was to investigate (a) whether early spot U_Na predicts 24-h diuretic efficiency and (b) the clinical factors associated with early spot U_Na in patients with AHF and concomitant renal dysfunction (RD). Methods: This is a post hoc analysis of the IMPROVE-HF trial, in which 160 patients with AHF and RD (estimated glomerular filtrate rate [eGFR] #x3c;60 mL/min/1.73 m²) were included. Diuretic efficiency was calculated as the net fluid output produced per 40 mg of furosemide equivalents in 24 h. The association between early spot U_Na and diuretic efficiency and clinical variables associated with U_Na were evaluated using multivariate linear regression analysis. The contribution of the exposures in the predictability of the models was assessed with the coefficient of determination (R²). Results: The mean age of the study population was 78 ± 8 years. The median (interquartile range) diuretic efficiency, early spot U_Na, aminoterminal pro-brain natriuretic peptide, and eGFR were 747 (490–1,167) mL, 90 mmol/L (65–111), 7,765 pg/mL (3,526–15,369), and 33.7 ± 11.3 mL/min/1.73 m², respectively. In a multivariate setting, lower U_Na was significantly and nonlinearly associated with lower diuretic efficiency (p = 0.001), explaining the 44.4% of the model predictability. Natremia and surrogates of congestion emerged as the main factors related to U_Na. Conclusions: In patients with AHF and RD at presentation, early spot U_Na was inversely related to 24-h diuretic efficiency.
Cardiorenal Med

中文翻译：

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急性心力衰竭和伴随肾功能障碍的早期点尿钠和利尿效率。

目的：在急性心力衰竭 (AHF) 中，尿钠 (U _Na ) 的早期评估已成为风险分层和监测的有用生物标志物。本研究的目的是调查 (a) 早期 U _Na是否预测 24 小时利尿效率，以及 (b)与 AHF 和伴随肾功能不全 (RD) 患者早期 U _Na相关的临床因素。方法：这是对 IMPROVE-HF 试验的事后分析，其中 160 名 AHF 和 RD 患者（估计肾小球滤过率 [eGFR] #x3c；60 mL/min/1.73 m ²) 被包括在内。利尿效率计算为 24 小时内每 40 毫克呋塞米当量产生的净液体输出。使用多元线性回归分析评估早期点 U _Na与利尿效率和与 U _Na相关的临床变量之间的关联。暴露对模型可预测性的贡献通过决定系数 ( R ² )进行评估。结果：研究人群的平均年龄为 78 ± 8 岁。中位数（四分位距）利尿效率，早期点 U _Na，氨基末端脑钠肽和EGFR 747（490-1,167）毫升，90毫摩尔/ L（65-111），7765皮克/毫升（3,526-15,369），和33.7±11.3毫升/分钟/1.73米²， 分别。在多变量环境中，较低的 U _Na与较低的利尿效率呈显着非线性相关 ( p = 0.001)，解释了模型可预测性的 44.4%。钠血症和充血替代物成为与 U _Na相关的主要因素。结论：就诊时患有 AHF 和 RD 的患者，早期点 U _Na与 24 小时利尿效率呈负相关。
心肾医学