Risk factors for diuretic resistance in hospitalized patients with acute decompensated heart failure: a retrospective study.

OBJECTIVE

To investigate the independent risk factors for diuretic resistance (DR) and its clinical impact in hospitalized patients with acute decompensated heart failure (ADHF).

METHODS

This single-center retrospective study consecutively enrolled 387 patients with ADHF admitted between January 2022 and June 2025. Based on an operational definition (intravenous furosemide ≥ 80 mg/day with failure to achieve an average daily body weight reduction ≥ 1 kg or a net negative fluid balance ≥ 1,000 mL within 72 h), patients were classified into a DR group (n = 132) and a non-DR group (n = 255). Demographic characteristics, comorbidities, laboratory parameters at admission, and medication history were collected and compared between groups. Multivariable logistic regression analysis (backward stepwise method) was performed to identify independent risk factors for DR, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of identified factors. A nomogram was then constructed to visualize the combined predictive model.

RESULTS

The incidence of DR among patients with ADHF was 34.11%. Nonsteroidal anti-inflammatory drug (NSAID) use within one week prior to admission, chronic kidney disease stage 3, and New York Heart Association (NYHA) functional class III-IV were independent risk factors for DR. Higher serum sodium levels, estimated glomerular filtration rate (eGFR), and serum albumin levels were identified as protective factors. Log-transformed and standardized N-terminal pro-B-type natriuretic peptide (NT-proBNP) was a very strong predictor of DR. Using the Youden index, the optimal cutoff value of baseline NT-proBNP for predicting DR was 1,003.19 pg/mL (sensitivity 81.06%, specificity 80.39%).

CONCLUSION

NT-proBNP and eGFR demonstrate good predictive value for DR. The occurrence of DR is significantly associated with prolonged hospitalization and an increased risk of renal function deterioration.