ArticleClinical research in cardiology : official journal of the German Cardiac Society2016
Spot urine sodium excretion as prognostic marker in acutely decompensated heart failure: the spironolactone effect.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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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.
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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.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- The value of urinary sodium assessment in acute heart failure.European heart journal. Acute cardiovascular care · 2021Pooled it
- Impact of mineralocorticoid receptor antagonists on the risk of sudden cardiac death in patients with heart failure and left-ventricular systolic dysfunction: an individual patient-level meta-analysis of three randomized-controlled trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2019Pooled it
- 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 · 2020Trial
- Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction.Clinical research in cardiology : official journal of the German Cardiac Society · 2017Trial
- Combined SGLT-2 Inhibitor and Mineralocorticoid Receptor Antagonist Therapy: Effects on the Renin-Angiotensin-Aldosterone System in Heart Failure Treatment.International journal of molecular sciences · 2026Article
- Effects of heart failure pharmacotherapy on natriuresis and diuresis: A narrative review.Heart failure reviews · 2026Review
- Urinary Biomarkers for the Risk Assessment and Management of Heart Failure: Pearls and Pitfalls.Current heart failure reports · 2026Review
- Intrarenal Hemodynamic Mechanisms of Kidney Protection by Nonsteroidal Mineralocorticoid Receptor Antagonists.Endocrinology and metabolism (Seoul, Korea) · 2026Review
- Elevated urinary sodium thresholds in high-salt diet heart failure: implications for diuretic resistance diagnosis.Frontiers in cardiovascular medicine · 2026Article
- Urinary markers in heart failure - types, timing and thresholds. European Journal of Heart Failure expert consensus document.European journal of heart failure · 2025Review
- The role of urine sodium in acutely decompensated heart failure.International journal of cardiology. Heart & vasculature · 2024Article
- The utility of urine sodium-guided diuresis during acute decompensated heart failure.Heart failure reviews · 2024Review
- The role of urine chloride in acute heart failure.Scientific reports · 2024Article
- Spot Urinary Sodium Measurements: the Future Direction of the Treatment and Follow-up of Patients with Heart Failure.Current heart failure reports · 2023Review
- Toward quantification of loop diuretic responsiveness for congestive heart failure.Journal of veterinary internal medicine · 2023Review
- Urinary sodium concentration predicts time to major adverse coronary events and all-cause mortality in men with heart failure over a 28-33-year period: a prospective cohort study.BMC cardiovascular disorders · 2022Article
- Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure.Journal of the American College of Cardiology · 2021Article
- Acute Cardiorenal Syndrome in Heart Failure: from Dogmas to Advances.Current cardiology reports · 2020Review
- [Update on heart failure].Herz · 2020Review
- Role of electrolyte concentrations and renin-angiotensin-aldosterone activation in the staging of canine heart disease.Journal of veterinary internal medicine · 2020Article
Corrections and comments
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Authors and funding
10 authors at 7 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionLoop diuretic resistance characterized by inefficient sodium excretion complicates many patients with acutely decompensated heart failure (ADHF). Mineralocorticoid receptor antagonists (MRAs) in natriuretic doses may improve spot urine sodium excretion and outcomes.
objectiveOur primary aim was to assess the association of high-dose spironolactone with short-term spot urine sodium excretion, and our secondary aim was to determine if this higher short-term spot urine sodium excretion is associated with reduction in the composite clinical outcome (of cardiovascular mortality and/or ADHF hospitalization) event rate at 180 days.
methodsSingle-centre, non-randomized, open-label study enrolling 100 patients with ADHF. Patients were treated with standard ADHF therapy alone (n = 50) or oral spironolactone 100 mg/day plus standard ADHF therapy (n = 50). Spot urine samples were collected at day 1 and day 3 of hospitalization.
resultsSpironolactone group had significantly higher spot urine sodium levels compared to standard care group at day 3 (84.13 ± 28.71 mmol/L vs 70.74 ± 34.43 mmol/L, p = 0.04). The proportion of patients with spot urinary sodium <60 mmol/L was lower in spironolactone group at day 3 (18.8 vs 45.7, p = 0.01). In multivariate analysis, spironolactone was independently associated with increased spot urinary sodium and urinary sodium/potassium ratio of >2 at day 3 (both, p < 0.05). Higher spot urine sodium levels were associated with a lower event rate [HR for urinary sodium >100 mmol/L = 0.16 (0.06-0.42), p < 0.01, compared to <60], and provided a significant prognostic gain measured by net reclassification indexes.
conclusionSpot urinary sodium levels >60 mmol/L and urinary sodium/potassium ratio >2 measured at day 3 of hospitalization for ADHF are associated with improved mid-term outcomes. Spironolactone is associated with increased spot urinary sodium and sodium/potassium ratio >2.
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