Usefulness of urinary potassium to creatinine ratio to predict diuretic response in patients with acute heart failure and preserved ejection fraction.
acute heart failure
diuretic response
preserved ejection fraction
urinary potassium creatinine ratio
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
revised:
06
05
2023
received:
27
05
2022
accepted:
10
05
2023
medline:
21
8
2023
pubmed:
8
6
2023
entrez:
8
6
2023
Statut:
ppublish
Résumé
Patients with acute heart failure (AHF) require intensification in the diuretic strategy. However, the optimal diuretic strategy remains unclear. In this work, we aimed to evaluate the role of urinary potassium to creatinine ratio (K/Cr) to predict diuretic and natriuretic response to thiazide or mineralocorticoid receptor antagonists (MRAs) in a cohort of patients with AHF and preserved ejection fraction (AHF-pEF). Patients with a high urinary K/Cr ratio will have a better diuretic and natriuretic response with spironolactone versus chlorthalidone. This is a study of 44 patients with AHF-pEF with suboptimal loop diuretic response. The primary endpoint was the baseline K/Cr associated with natriuretic and diuretic effect of chlorthalidone versus spironolactone at 24 and 72 h. Mixed linear regression models were used to analyze the endpoints. Estimates were reported as least squares mean with their respective 95% confidence interval (CIs). The median age of the study population was 85 years (82.5-88.5), and 30 (68.2%) were women. The inferential multivariate analysis suggested a greater natriuretic and diuretic effect of chlorthalidone across K/Cr levels. In the upper category, chlorthalidone translated into a statistically increase in natriuresis at 24 and 72 h. Chlorthalidone versus spironolactone showed ∆uNa of 25.7 mmol/L at 24 h (95% CI = -3.7 to 55.4, p = .098) and ∆uNa of 24.8 mmol/L at 72 h (95% CI = -4 to 53.6, p = .0106). The omnibus p value is .027. Multivariate analyses revealed a significant increase in 72 h cumulative diuresis irrespective of K/Cr status in those on chlorthalidone. In patients with AHF-pEF and suboptimal diuretic response, diuresis and natriuresis are higher with the administration of chlorthalidone over spironolactone. These data don't support the hypothesis that the K/Cr ratio can help guide the choice of thiazide diuretic versus MRA in AHF-pEF patients on loop diuretic.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with acute heart failure (AHF) require intensification in the diuretic strategy. However, the optimal diuretic strategy remains unclear. In this work, we aimed to evaluate the role of urinary potassium to creatinine ratio (K/Cr) to predict diuretic and natriuretic response to thiazide or mineralocorticoid receptor antagonists (MRAs) in a cohort of patients with AHF and preserved ejection fraction (AHF-pEF).
HYPOTHESIS
OBJECTIVE
Patients with a high urinary K/Cr ratio will have a better diuretic and natriuretic response with spironolactone versus chlorthalidone.
METHODS
METHODS
This is a study of 44 patients with AHF-pEF with suboptimal loop diuretic response. The primary endpoint was the baseline K/Cr associated with natriuretic and diuretic effect of chlorthalidone versus spironolactone at 24 and 72 h. Mixed linear regression models were used to analyze the endpoints. Estimates were reported as least squares mean with their respective 95% confidence interval (CIs).
RESULTS
RESULTS
The median age of the study population was 85 years (82.5-88.5), and 30 (68.2%) were women. The inferential multivariate analysis suggested a greater natriuretic and diuretic effect of chlorthalidone across K/Cr levels. In the upper category, chlorthalidone translated into a statistically increase in natriuresis at 24 and 72 h. Chlorthalidone versus spironolactone showed ∆uNa of 25.7 mmol/L at 24 h (95% CI = -3.7 to 55.4, p = .098) and ∆uNa of 24.8 mmol/L at 72 h (95% CI = -4 to 53.6, p = .0106). The omnibus p value is .027. Multivariate analyses revealed a significant increase in 72 h cumulative diuresis irrespective of K/Cr status in those on chlorthalidone.
CONCLUSIONS
CONCLUSIONS
In patients with AHF-pEF and suboptimal diuretic response, diuresis and natriuresis are higher with the administration of chlorthalidone over spironolactone. These data don't support the hypothesis that the K/Cr ratio can help guide the choice of thiazide diuretic versus MRA in AHF-pEF patients on loop diuretic.
Identifiants
pubmed: 37287326
doi: 10.1002/clc.24040
pmc: PMC10436792
doi:
Substances chimiques
Diuretics
0
Spironolactone
27O7W4T232
Creatinine
AYI8EX34EU
Sodium Potassium Chloride Symporter Inhibitors
0
Chlorthalidone
Q0MQD1073Q
Potassium
RWP5GA015D
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
906-913Informations de copyright
© 2023 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.
Références
Eur Heart J. 2022 Feb 10;43(6):440-441
pubmed: 34922348
Am J Cardiovasc Drugs. 2018 Oct;18(5):415-422
pubmed: 29971596
Cardiology. 2001;96(3-4):132-43
pubmed: 11805380
Am Heart J. 1975 Feb;89(2):163-70
pubmed: 1090132
Eur Heart J. 2016 Jul 14;37(27):2129-2200
pubmed: 27206819
JAMA Cardiol. 2017 Sep 1;2(9):950-958
pubmed: 28700781
Eur J Heart Fail. 2019 Feb;21(2):137-155
pubmed: 30600580
Curr Heart Fail Rep. 2015 Dec;12(6):367-78
pubmed: 26486631
Am J Nephrol. 1991;11(6):441-6
pubmed: 1840232
Int J Cardiol. 2014 Jan 1;170(3):e68-9
pubmed: 24268982
Endocr Rev. 1985 Winter;6(1):24-44
pubmed: 3884328
Semin Nephrol. 2013 May;33(3):215-28
pubmed: 23953799
Clin Cardiol. 2023 Aug;46(8):906-913
pubmed: 37287326
Am J Med. 1998 Jun;104(6):533-8
pubmed: 9674715
Eur Heart J Acute Cardiovasc Care. 2022 Jun 7;11(4):350-355
pubmed: 35167653
Eur J Heart Fail. 2021 Sep;23(9):1445-1457
pubmed: 34241936
J Am Coll Cardiol. 2010 Nov 2;56(19):1527-34
pubmed: 21029871
Eur Heart J. 1996 Dec;17(12):1867-74
pubmed: 8960430