Abstract: PUB010
Can Spot Urine Sodium Improve Diuresis in Cardiorenal Syndrome?
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Navrota, Pavlo, Ross University School of Medicine, Miami, Florida, United States
- Arsene, Camelia, Trinity Health, Livonia, Michigan, United States
Background
Neurohormonal resistance to diuretics and poor renal function complicate volume management in patients with acute decompensated heart failure (ADHF) and chronic kidney disease (CKD). Identifying inadequate diuretic response through fluid intake/output and body weight can be cumbersome and time intensive. Spot urine sodium is an attractive alternative that if protocolized can help titration of diuretic therapy.
Methods
A review was performed using PubMed and Google Scholar (2015-2026) to identify studies evaluating spot urine sodium or natriuresis-guided diuretic strategies in adults hospitalized with ADHF. Search terms included “urine sodium,” “natriuresis,” “diuretic response,” “heart failure,” “cardiorenal syndrome,” and “chronic kidney disease.” Reference lists of recent review articles were searched to identify additional studies. Studies involving outpatient, or non-English publications were excluded.
Results
Prior to 2022, evidence consisted primarily of 19 prospective observational studies where low urine sodium predicted inadequate response to diuretic, longer hospital stay, and mortality difference up to 12 months. More recently 5 randomised trials (60-400 patients each) were able to feasibly protocolize sodium guided diuresis. Trial outcomes showed improvement in congestion and timely symptom relief while having similar rates of kidney injury, hospital stay, readmission, and short term mortality. While current trials contain a modest amount of comorbid CKD patients, they are not powered for CKD subgroup outcomes, and advanced CKD (eGFR <30) is still underrepresented.
Conclusion
Spot urine sodium-guided diuresis is an emerging strategy that may allow earlier titration of diuretic medication in acute heart failure while allowing efficient short term decongestion and safety outcomes. While current small randomized studies show similar acute kidney injury rates, patients with CKD are underrepresented in prior natriuresis-guided diuresis studies despite representing a high-risk cohort.