Current problems in cardiology · 2026
Urinary chlorine at hospital admission as a predictor of diuretic resistance and clinical evolution in acute heart failure.
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Scatularo Cristhian E, Chango Acurio Gardenia L, Battioni Luciano, Guazzone Analía, Grancelli Hugo O
Аннотация
INTRODUCTION: The natriuresis measurement is useful to diagnose diuretic resistance (DR) and adjust furosemide doses in acute heart failure (AHF) hospitalized patients, but the utility of urinary chloride is unknown.
OBJECTIVES: To correlate the urine chloride at admission (UCLA) in AHF patients with the development of DR and cardiovascular (CV) events at the 180-day outpatient follow-up.
METHODOLOGY: A prospective study included patients hospitalized for AHF, without shock, creatinine >2.5 mg/dL or mechanical respiratory support at admission. They received 40 mg of intravenous furosemide at admission, UCLA was measured, and diuretic treatment was based on a protocol. DR was defined as the requirement for furosemide ≥240 mg/day, sequential nephron diuretic blocked (SNB), hypertonic saline serum, or renal replacement therapy.
RESULTS: 116 patients were included, 51% were men, UCLA was 105 meq/L, and DR was developed in 17% of patients. The UCLA was associated with the development of DR (p 0.0001; AUC ROC curve 0.81; cut-off point 96 meq/L). UCLA <96 meq/L was associated with persistent congestion (p 0.01), furosemide ≥240 mg/day use (p 0.004), worsening of AHF (p 0.002) and renal function (p 0.02), use of SNB (p 0.001) and inotropic drugs (p 0.007), a longer hospital stay (p 0.02) and a higher CV death (p 0.05). At 180-day follow-up, UCLA <96 meq/L was associated with AHF readmissions (p 0.002).
CONCLUSION: In AHF hospitalized patients, low UCLA was associated with DR, persistent congestion, need for more aggressive decongestion strategies, worse in-hospital clinical outcomes and more AHF hospitalizations at 6 months.
OBJECTIVES: To correlate the urine chloride at admission (UCLA) in AHF patients with the development of DR and cardiovascular (CV) events at the 180-day outpatient follow-up.
METHODOLOGY: A prospective study included patients hospitalized for AHF, without shock, creatinine >2.5 mg/dL or mechanical respiratory support at admission. They received 40 mg of intravenous furosemide at admission, UCLA was measured, and diuretic treatment was based on a protocol. DR was defined as the requirement for furosemide ≥240 mg/day, sequential nephron diuretic blocked (SNB), hypertonic saline serum, or renal replacement therapy.
RESULTS: 116 patients were included, 51% were men, UCLA was 105 meq/L, and DR was developed in 17% of patients. The UCLA was associated with the development of DR (p 0.0001; AUC ROC curve 0.81; cut-off point 96 meq/L). UCLA <96 meq/L was associated with persistent congestion (p 0.01), furosemide ≥240 mg/day use (p 0.004), worsening of AHF (p 0.002) and renal function (p 0.02), use of SNB (p 0.001) and inotropic drugs (p 0.007), a longer hospital stay (p 0.02) and a higher CV death (p 0.05). At 180-day follow-up, UCLA <96 meq/L was associated with AHF readmissions (p 0.002).
CONCLUSION: In AHF hospitalized patients, low UCLA was associated with DR, persistent congestion, need for more aggressive decongestion strategies, worse in-hospital clinical outcomes and more AHF hospitalizations at 6 months.