PUSH-AHF
Trial question
What is the role of natriuresis-guided diuretic therapy in patients with acute HF?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
45.0% female
55.0% male
N = 310
310 patients (138 female, 172 male).
Inclusion criteria: patients with acute HF requiring treatment with intravenous loop diuretics.
Key exclusion criteria: severe renal impairment requiring ultrafiltration or dialysis; dyspnea due to other causes.
Interventions
N=150 natriuresis-guided therapy (natriuresis determined at set timepoints, prompting treatment intensification if spot urinary sodium levels < 70 mmol/L).
N=160 standard of care (intravenous loop diuretic without any treatment intensification).
Primary outcome
Urinary sodium excretion at 24 hours
409 mmol
345 mmol
409.0 mmol
306.8 mmol
204.5 mmol
102.3 mmol
0.0 mmol
Natriuresis-guided
therapy
Standard of
care
Significant
increase ▲
Significant increase in urinary sodium excretion at 24 hours (409 mmol vs. 345 mmol; AD 63 mmol, 95% CI 18 to 109).
Secondary outcomes
No significant difference in all-cause mortality or HF rehospitalization at 180 days (31% vs. 31%; HR 0.92, 95% CI 0.62 to 1.38).
Significant increase in natriuresis at 48 hours (653 mmol vs. 575 mmol; AD 78 mmol, 95% CI 10 to 145).
No significant difference in HF rehospitalization (17% vs. 17%; HR 0.96, 96% CI 0.56 to 1.67).
Safety outcomes
No significant difference in renal events.
Conclusion
In patients with acute HF requiring treatment with intravenous loop diuretics, natriuresis-guided therapy was superior to standard of care with respect to urinary sodium excretion at 24 hours.
Reference
Jozine M Ter Maaten, Iris E Beldhuis, Peter van der Meer et al. Natriuresis-guided diuretic therapy in acute heart failure: a pragmatic randomized trial. Nat Med. 2023 Oct;29(10):2625-2632.
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