Design and rationale of the Urine Sodium-directed Diuretic Adjustment Strategy in Heart Failure (US-DASH) trial.

RATIONALE: Recent studies have shown natriuresis-guided diuretic adjustment strategies result in greater natriuresis and diuresis than the standard of practice in acute heart failure. There is no consensus for which natriuretic goal optimally balances decongestion with adverse clinical outcomes.

PRIMARY HYPOTHESIS: This study will test the hypothesis that (i.) a high-threshold natriuresis target improves natriuresis compared with both a low-threshold natriuretic strategy and traditional methods, and (ii.) natriuresis in absence of urine output monitoring can safely guide management. The primary endpoint is 24-hour natriuresis.

DESIGN

Pragmatic, single-center, randomized, controlled, open-label with stratification by eGFR (greater than versus less than 60 mL/min/1.73 m²) and number of home diuretics (0-1 versus 2+).