ArticleJournal of the American College of Cardiology2021
Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure.
Article in Journal of the American College of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Protocolized natriuresis-guided diuretic therapy in acute heart failure: a systematic review and meta-analysis.Critical care (London, England) · 2025Pooled it
- Systematic Review on the Management of Diuretic Resistance in Acute Heart Failure across the Spectrum of Kidney Disease.Cardiorenal medicine · 2025Pooled it
- Natriuresis-guided diuretic therapy in acute heart failure: a pragmatic randomized trial.Nature medicine · 2023Trial
- Diuretics in Cardiovascular Disease: For How Long and at What Dose?Journal of cardiovascular development and disease · 2026Review
- Performances of Clinical, Biological and Echographic Signs to Assess Right Atrial Pressure in Pulmonary Hypertension.Journal of clinical medicine · 2026Article
- A Novel, Interpretable Machine Learning Model Predicts Furosemide Dosing After Congenital Cardiac Surgery.Pediatric cardiology · 2026Article
- Loop Diuretic Dose Intensification versus Adjuvant Thiazide for Diuretic Resistance in Acute Heart Failure: Mechanistic Randomized Controlled Trial.Journal of the American Society of Nephrology : JASN · 2026Article
- Elevated urinary sodium thresholds in high-salt diet heart failure: implications for diuretic resistance diagnosis.Frontiers in cardiovascular medicine · 2026Article
- Decongestion in heart failure: medical and device therapies.Nature reviews. Cardiology · 2025Review
- Urinary markers in heart failure - types, timing and thresholds. European Journal of Heart Failure expert consensus document.European journal of heart failure · 2025Review
- Natriuretic response prediction equation for use with oral diuretics in heart failure.European heart journal · 2025Article
- Diuretic strategies in acute decompensated heart failure.Heart failure reviews · 2025Review
- Development of a Novel Intraperitoneal Icodextrin/Dextrose Solution for Enhanced Sodium Removal.Kidney medicine · 2025Article
- The utility of urine sodium-guided diuresis during acute decompensated heart failure.Heart failure reviews · 2024Review
- The Changing Role of Loop Diuretics in Heart Failure Management across the Last Century.Journal of clinical medicine · 2024Review
- Prognostic Impact of Induced Natriuresis in Acute Decompensated Heart Failure and Its Association with Intraabdominal Pressure and Other Congestion Markers: A Multimodal Approach to Congestion Assessment.Journal of clinical medicine · 2024Article
- Diuretic Combination Therapy in Acute Heart Failure: An Updated Review.Current pharmaceutical design · 2024Review
- Randomized controlled trial of urinE chemiStry guided aCute heArt faiLure treATmEnt (ESCALATE): Rationale and design.American heart journal · 2023Article
- Spot Urinary Sodium as a Biomarker of Diuretic Response in Acute Heart Failure.Journal of the American Heart Association · 2023Article
- In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility.Circulation. Heart failure · 2023Article
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Authors and funding
20 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundMost acute decompensated heart failure admissions are driven by congestion. However, residual congestion is common and often driven by the lack of reliable tools to titrate diuretic therapy. The authors previously developed a natriuretic response prediction equation (NRPE), which predicts sodium output using a spot urine sample collected 2 h after loop diuretic administration.
objectivesThe purpose of this study was to validate the NRPE and describe proof-of-concept that the NRPE can be used to guide diuretic therapy.
methodsTwo cohorts were assembled: 1) the Diagnosing and Targeting Mechanisms of Diuretic Resistance (MDR) cohort was used to validate the NRPE to predict 6-h sodium output after a loop diuretic, which was defined as poor (<50 mmol), suboptimal (<100 mmol), or excellent (>150 mmol); and 2) the Yale Diuretic Pathway (YDP) cohort, which used the NRPE to guide loop diuretic titration via a nurse-driven automated protocol.
resultsEvaluating 638 loop diuretic administrations, the NRPE showed excellent discrimination with areas under the curve ≥0.90 to predict poor, suboptimal, and excellent natriuretic response, and outperformed clinically obtained net fluid loss (p < 0.05 for all cutpoints). In the YDP cohort (n = 161) using the NRPE to direct therapy mean daily urine output (1.8 ± 0.9 l vs. 3.0 ± 0.8 l), net fluid output (-1.1 ± 0.9 l vs. -2.1 ± 0.9 l), and weight loss (-0.3 ± 0.3 kg vs. -2.5 ± 0.3 kg) improved substantially following initiation of the YDP (p < 0.001 for all pre-post comparisons).
conclusionsNatriuretic response can be rapidly and accurately predicted by the NRPE, and this information can be used to guide diuretic therapy during acute decompensated heart failure. Additional study of diuresis guided by the NRPE is warranted.
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Registered trials
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.