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Abstract: TH-OR102

Predictors to Identify Diuretic Resistance Early in Acute Decompensated Heart Failure (ADHF)

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials


  • Bansal, Shweta, University of Texas Health at San Antonio, San Antonio, Texas, United States
  • Munoz, Kristina Marie, Central Michigan University College of Medicine, Mount Pleasant, Michigan, United States
  • Brune, Sonja D., UT Health San Antonio, San Antonio, Texas, United States
  • Prasad, Anand, UT Health San Antonio, San Antonio, Texas, United States
  • Velagapudi, Chakradhar, University of Texas Health at San Antonio, San Antonio, Texas, United States

Resistance to loop-diuretics occurs frequently in patients hospitalized for ADHF, resulting in inadequate decongestion, readmission and poor outcomes. Early identification of diuretic resistance during the hospital course may avoid delay in institution of appropriate therapies. We aimed to identify clinical biomarkers that predicted diuretic resistance in a study conducted to evaluate usefulness of high-dose spironolactone in loop-diuretic resistant ADHF patients.


The parent trial was a prospective, non-randomized trial in ADHF patients. Diuretic resistance was identified if subjects had weight loss<1lb/day despite intravenous furosemide>160mg/day (at least one dose of 80mg/day) or no change in dyspnea 48H after admission with usual care. Baseline clinical characteristics, blood chemistry including neurohormones and urine electrolytes were compared between diuretic-responsive and resistant subjects.


Twenty of 47 enrolled subjects met loop-diuretic resistance criteria. The mean age was 61±15 yrs, 60% were male, and 50% were Hispanic. There was no difference in age, gender and race, co-morbidities, sign and symptoms of hypervolemia, renal function, EF%, presence of pulmonary HTN between diuretic-responsive and resistant subjects. However, serum sodium was lower (137[134,139] vs. 139[137,141]meq/L, p<0.03) and blood urea nitrogen was higher (11.42[7.60,3.18] vs. 7.68[5.71,8.92]mmol/l, p=0.009) in diuretic resistant compared to responsive subjects. Diuretic-resistant subjects had higher plasma renin activity (7.2[1.5,29.5] vs. 2[0.2,10.9]ng/ml/hr, p=0.03) and aldosterone (26.5[9.9, 56] vs. 5.2[3.7, 8.2] ng/dL, p<0.001), and lower urine sodium-potassium ratio (2.63±1.2 vs. 8.2±4.8, p<0.001). Plasma aldosterone had an inverse relationship with urine sodium-potassium ratio and (r=-0.46, p=0.003), but not with serum sodium or urea nitrogen. Urine sodium-potassium ratio at admission predicted loop-diuretic resistance with an AUC (95%CI) 0.69 (0.68, 0.71). A cutoff value of 2.96 had a sensitivity of 76% and specificity of 65% to identify loop-diuretic resistance (lower the value, more the resistance).


The admission urine sodium-potassium ratio may serve as a surrogate for high aldosterone activity, and is an inexpensive and rapidly available biomarker to recognize diuretic resistance in ADHF patients.


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