Evidence map›Paper›PMID 24704538›Full record

Observational studyJournal of cardiac failure2014

Insufficient natriuretic response to continuous intravenous furosemide is associated with poor long-term outcomes in acute decompensated heart failure.

Dhssraj Singh, Kevin Shrestha, Jeffrey M Testani, Frederik H Verbrugge, Matthias Dupont, Wilfried Mullens, W H Wilson Tang

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of cardiac failure, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 1 pooled it
5.9field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

70 citing papers in PubMed, 1 synthesis or guideline pooled it, 160 citations in OpenAlex.

  1. The value of urinary sodium assessment in acute heart failure.European heart journal. Acute cardiovascular care · 2021
    Pooled it
  2. Trial
  3. Trial
  4. Spot urinary sodium in acute decompensation of advanced heart failure and dilutional hyponatremia: insights from DRAIN trial.Clinical research in cardiology : official journal of the German Cardiac Society · 2020
    Trial
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  7. Review
  8. Article
  9. Article
  10. Article
  11. Article
  12. Review
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  14. Review
  15. Evolving Decongestion Strategies in the Management of Acute Heart Failure.Current treatment options in cardiovascular medicine · 2025
    Review
  16. The role of urine sodium in acutely decompensated heart failure.International journal of cardiology. Heart & vasculature · 2024
    Article
  17. Review
  18. Article
  19. Review
  20. Optimizing Postoperative Acute Kidney Injury Monitoring Using a Urine Biochemical Approach-Time to Bring More Dynamism to Serum Creatinine Evaluation!Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024
    Article

10 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 2 countries.

Dhssraj SinghDivision of Cardiovascular Diseases, Department of Medicine, University of Kansas, Kansas City, Kansas.
Kevin ShresthaDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Jeffrey M TestaniDepartment of Internal Medicine and Program of Applied Translational Research, Yale, University School of Medicine, New Haven, Connecticut.
Frederik H VerbruggeDepartment of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
Matthias DupontDepartment of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Wilfried MullensDepartment of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
W H Wilson TangDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: tangw@ccf.org.
Ziekenhuis Oost-Limburg · BECleveland Clinic · USUniversity of Kansas · USYale University · US

Funding

Clinical and Translational Science Collaborative of ClevelandUL1TR000439 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI KONSTAN, MICHAEL W. · 2012 to 2016
$50.0M
Nitrative stress in heart failureR01HL103931 · NHLBI · CLEVELAND CLINIC LERNER COM-CWRU · PI TANG, WAI HONG WILSON · 2010 to 2014
$3.8M
Cardio-renal phenotype and prognosis in chronic heart failureK23HL114868 · NHLBI · YALE UNIVERSITY · PI TESTANI, JEFFREY M · 2012 to 2017
$845k
NCATS NIH HHS UL1 TR000439NCATS NIH HHS UL1TR 000439NHLBI NIH HHS K23 HL114868NHLBI NIH HHS K23HL114868NHLBI NIH HHS R01 HL103931NHLBI NIH HHS R01HL103931
6 · The paper itself

Abstract

backgroundTreatment of acute decompensated heart failure (ADHF) with loop diuretics, such as furosemide, is frequently complicated by insufficient urine sodium excretion. We hypothesize that insufficient natriuretic response to diuretic therapy, characterized by lower urine sodium (UNa) and urine furosemide, is associated with subsequent inadequate decongestion, worsening renal function, and adverse long term events. METHODS AND

resultsWe enrolled 52 consecutive patients with ADHF and measured serum and urine sodium (UNa), urine creatinine (UCr), and urine furosemide (UFurosemide) levels on a spot sample taken after treatment with continuous intravenous furosemide, and followed clinical and renal variables as well as adverse long-term clinical outcomes (death, rehospitalizations, and cardiac transplantation). We observed similar correlations between UNa:UFurosemide ratio and UNa and fractional excretion of sodium (FENa) with 24-hour net urine output (r = 0.52-0.64, all P < .01) and 24-hour weight loss (r = 0.44-0.56; all P < .01). Interestingly, FENa (but not UNa or UNa:UFurosemide) were influenced by estimated glomerular filtration rate (eGFR). We observed an association between lower UNa:UFurosemide with greater likelihood of worsening renal function (hazard ratio [HR] 3.01; P = .02) and poorer adverse clinical outcomes (HR 1.63, P = .008) after adjusting for age and eGFR. Meanwhile, both diminished weight loss and net fluid output over 24 hours of continuous intravenous furosemide were observed when UNa:UFurosemide ratios were <2 mmol/mg or when UNa <50 mmol.

conclusionIn patients with ADHF receiving continuous furosemide infusion, impaired natriuretic response to furosemide is associated with greater likelihood of worsening renal function and future adverse long-term outcomes, independently from and incrementally with decreasing intrinsic glomerular filtration.

Indexed as

Acute DiseaseAdultAgedBiomarkersCohort StudiesFemaleFurosemideHeart FailureHumansInfusions, IntravenousMaleMiddle AgedNatriuretic Peptide, BrainProspective StudiesSodium Potassium Chloride Symporter InhibitorsTreatment OutcomeBiomarkersFurosemideNatriuretic Peptide, BrainSodium Potassium Chloride Symporter InhibitorsAcute decompensated heart failurefurosemidenatriuresisurine sodium

Identifiers

PMID24704538
PMCPMC4067259
OpenAlexW2123614185

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.