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Neal K Lakdawala - One of the best experts on this subject based on the ideXlab platform.
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lower Urine Sodium predicts longer length of stay in acute heart failure patients insights from the rose ahf trial
Clinical Cardiology, 2020Co-Authors: Jonathan W Cunningham, Joann Lindenfeld, Lynne W Stevenson, Kevin J Anstrom, Michael M Givertz, Jielena Sun, Finnian Mc R Causland, Neal K LakdawalaAbstract:BACKGROUND In patients hospitalized with acute heart failure (AHF), low Urine Sodium concentration (UNa ) after diuretic treatment may identify patients at risk for longer length of stay (LOS) and adverse events. We investigated the prognostic significance of 24-hour cumulative postdiuretic Urine Sodium concentration in a multicenter clinical trial population. METHODS The Renal Optimization Strategies Evaluation AHF (ROSE AHF) trial randomized 360 patients with AHF and renal dysfunction receiving intravenous diuretic to dopamine, nesiritide, or placebo. Sodium concentration was measured in cumulative Urine sample collected during the first 24 hours after randomization in 298 patients. Based on prior studies, lower UNa was defined as ≤60 mmol/L. RESULTS Lower UNa was present in 142 (48%) patients, who had longer LOS (7 days vs 5 days, P < .001) and less 72-hour weight loss (5.7 lb vs 9.0 lb, P < .001). These associations persisted after controlling for baseline estimated glomerular filtration rate and outpatient furosemide dose. Lower UNa did not modify the null effects of dopamine or nesiritide on clinical outcomes. Results were similar for spot rather than cumulative 24-hour UNa concentration. CONCLUSION In patients hospitalized for AHF and renal dysfunction, UNa ≤ 60 mmol/L during the first 24 hours of diuresis identifies patients at risk for prolonged hospitalization but does not provide an indication for adjunctive dopamine or nesiritide.
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low Urine Sodium predicts length of stay but not response to dopamine or nesiritide in hospitalized patients with acute heart failure and renal dysfunction
Journal of the American College of Cardiology, 2019Co-Authors: Jonathan W Cunningham, Joann Lindenfeld, Lynne W Stevenson, Jie Sun, Kevin J Anstrom, Michael M Givertz, Neal K LakdawalaAbstract:In patients hospitalized with acute heart failure (AHF), low Urine Sodium (UNa) after diuretic may identify patients at risk for longer length of stay (LOS) and adverse events. We investigated whether patients with low UNa benefit from dopamine or nesiritide. The Renal Optimization Strategies
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first spot Urine Sodium after initial diuretic identifies patients at high risk for adverse outcome after heart failure hospitalization
American Heart Journal, 2018Co-Authors: Adriana Luk, Joann Lindenfeld, Akshay S Desai, Lynne W Stevenson, John D Groarke, Syed S Mahmood, Deepa M Gopal, Emer Joyce, Sachin P Shah, Neal K LakdawalaAbstract:Abstract Background Relief of congestion is the primary goal of initial therapy for acute decompensated heart failure (ADHF). Early measurement of Urine Sodium concentration (UNa) may be useful to identify patients with diminished response to diuretics. The aim of this study was to determine if the first spot UNa after diuretic initiation could select patients likely to require more intensive therapy during hospitalization. Methods At the time of admission, 103 patients with ADHF were identified prospectively, and UNa was measured after the first dose of intravenous diuretic. Clinical outcomes were compared for patients with UNa >60 mmol/L and UNa of ≤60 mmol/L, with the primary outcome of a composite of death at 90 days, mechanical circulatory support during admission, and requirement of inotropic support at discharge. Results Patients with UNa ≤60 had lower admission blood pressure, had less chronic neurohormonal antagonist prior to admission, and were more than twice as likely to experience the primary end point (hazard ratio 2.40, 95% CI 1.02-5.66, P = .045), which was marginally significant after adjusting for renal function and baseline home loop diuretic. Worsening renal function was significantly more common in patients with UNa 60. Conclusions Assessment of spot UNa after initial intravenous loop diuretic administration may facilitate identification and triage of a population of HF patients at increased risk for adverse events and prolonged hospitalization.
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spot Urine Sodium as triage for effective diuretic infusion in an ambulatory heart failure unit
Journal of Cardiac Failure, 2018Co-Authors: Marshall D Brinkley, Laura J Burpee, Sunitpreet Chaudhry, Jennifer A Smallwood, Joann Lindenfeld, Neal K Lakdawala, Akshay S Desai, Lynne W StevensonAbstract:Abstract Background Admission for diuresis remains a common and costly event in patients with advanced heart failure (HF). We tested whether spot Urine Sodium could identify patients likely to respond to ambulatory diuretic infusion without hospitalization. Methods and Results We prospectively followed 176 consecutive patients with advanced heart failure receiving intravenous furosemide for congestion in an ambulatory clinic. Spot Urine Sodium was measured in 1st voided Urine after diuretic infusion and compared with 3-hour Urine output and subsequent risk of 30-day hospitalization or emergency department (ED) visit. Spot Urine Sodium was significantly associated with Urine output in a model adjusted for age, renal function, and blood urea nitrogen (P = .02). Higher Urine Sodium was associated with lower risk of hospitalization or ED visit within 30 days (odds ratio [OR] 0.82 [95% confidence interval 0.72–0.94] per 10 mmol/L increase; P Conclusion High spot Urine Sodium after diuretic administration identifies HF patients likely to respond to an ambulatory diuretic infusion with lower rates of hospitalization or ED visits at 30 days.
Lynne W Stevenson - One of the best experts on this subject based on the ideXlab platform.
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lower Urine Sodium predicts longer length of stay in acute heart failure patients insights from the rose ahf trial
Clinical Cardiology, 2020Co-Authors: Jonathan W Cunningham, Joann Lindenfeld, Lynne W Stevenson, Kevin J Anstrom, Michael M Givertz, Jielena Sun, Finnian Mc R Causland, Neal K LakdawalaAbstract:BACKGROUND In patients hospitalized with acute heart failure (AHF), low Urine Sodium concentration (UNa ) after diuretic treatment may identify patients at risk for longer length of stay (LOS) and adverse events. We investigated the prognostic significance of 24-hour cumulative postdiuretic Urine Sodium concentration in a multicenter clinical trial population. METHODS The Renal Optimization Strategies Evaluation AHF (ROSE AHF) trial randomized 360 patients with AHF and renal dysfunction receiving intravenous diuretic to dopamine, nesiritide, or placebo. Sodium concentration was measured in cumulative Urine sample collected during the first 24 hours after randomization in 298 patients. Based on prior studies, lower UNa was defined as ≤60 mmol/L. RESULTS Lower UNa was present in 142 (48%) patients, who had longer LOS (7 days vs 5 days, P < .001) and less 72-hour weight loss (5.7 lb vs 9.0 lb, P < .001). These associations persisted after controlling for baseline estimated glomerular filtration rate and outpatient furosemide dose. Lower UNa did not modify the null effects of dopamine or nesiritide on clinical outcomes. Results were similar for spot rather than cumulative 24-hour UNa concentration. CONCLUSION In patients hospitalized for AHF and renal dysfunction, UNa ≤ 60 mmol/L during the first 24 hours of diuresis identifies patients at risk for prolonged hospitalization but does not provide an indication for adjunctive dopamine or nesiritide.
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low Urine Sodium predicts length of stay but not response to dopamine or nesiritide in hospitalized patients with acute heart failure and renal dysfunction
Journal of the American College of Cardiology, 2019Co-Authors: Jonathan W Cunningham, Joann Lindenfeld, Lynne W Stevenson, Jie Sun, Kevin J Anstrom, Michael M Givertz, Neal K LakdawalaAbstract:In patients hospitalized with acute heart failure (AHF), low Urine Sodium (UNa) after diuretic may identify patients at risk for longer length of stay (LOS) and adverse events. We investigated whether patients with low UNa benefit from dopamine or nesiritide. The Renal Optimization Strategies
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first spot Urine Sodium after initial diuretic identifies patients at high risk for adverse outcome after heart failure hospitalization
American Heart Journal, 2018Co-Authors: Adriana Luk, Joann Lindenfeld, Akshay S Desai, Lynne W Stevenson, John D Groarke, Syed S Mahmood, Deepa M Gopal, Emer Joyce, Sachin P Shah, Neal K LakdawalaAbstract:Abstract Background Relief of congestion is the primary goal of initial therapy for acute decompensated heart failure (ADHF). Early measurement of Urine Sodium concentration (UNa) may be useful to identify patients with diminished response to diuretics. The aim of this study was to determine if the first spot UNa after diuretic initiation could select patients likely to require more intensive therapy during hospitalization. Methods At the time of admission, 103 patients with ADHF were identified prospectively, and UNa was measured after the first dose of intravenous diuretic. Clinical outcomes were compared for patients with UNa >60 mmol/L and UNa of ≤60 mmol/L, with the primary outcome of a composite of death at 90 days, mechanical circulatory support during admission, and requirement of inotropic support at discharge. Results Patients with UNa ≤60 had lower admission blood pressure, had less chronic neurohormonal antagonist prior to admission, and were more than twice as likely to experience the primary end point (hazard ratio 2.40, 95% CI 1.02-5.66, P = .045), which was marginally significant after adjusting for renal function and baseline home loop diuretic. Worsening renal function was significantly more common in patients with UNa 60. Conclusions Assessment of spot UNa after initial intravenous loop diuretic administration may facilitate identification and triage of a population of HF patients at increased risk for adverse events and prolonged hospitalization.
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spot Urine Sodium as triage for effective diuretic infusion in an ambulatory heart failure unit
Journal of Cardiac Failure, 2018Co-Authors: Marshall D Brinkley, Laura J Burpee, Sunitpreet Chaudhry, Jennifer A Smallwood, Joann Lindenfeld, Neal K Lakdawala, Akshay S Desai, Lynne W StevensonAbstract:Abstract Background Admission for diuresis remains a common and costly event in patients with advanced heart failure (HF). We tested whether spot Urine Sodium could identify patients likely to respond to ambulatory diuretic infusion without hospitalization. Methods and Results We prospectively followed 176 consecutive patients with advanced heart failure receiving intravenous furosemide for congestion in an ambulatory clinic. Spot Urine Sodium was measured in 1st voided Urine after diuretic infusion and compared with 3-hour Urine output and subsequent risk of 30-day hospitalization or emergency department (ED) visit. Spot Urine Sodium was significantly associated with Urine output in a model adjusted for age, renal function, and blood urea nitrogen (P = .02). Higher Urine Sodium was associated with lower risk of hospitalization or ED visit within 30 days (odds ratio [OR] 0.82 [95% confidence interval 0.72–0.94] per 10 mmol/L increase; P Conclusion High spot Urine Sodium after diuretic administration identifies HF patients likely to respond to an ambulatory diuretic infusion with lower rates of hospitalization or ED visits at 30 days.
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abstract 16430 early Urine Sodium response after ambulatory diuretic bolus to avoid heart failure hospitalization
Circulation, 2014Co-Authors: Laura J Burpee, Jennifer A Smallwood, Akshay S Desai, Lynne W Stevenson, Michelle Young, Irene M Cooper, Kristina Navarrovelez, Elaine L Shea, Craig A Stevens, Cindy WeiffenbachAbstract:Introduction: Ambulatory heart failure management may increasingly include administration of intravenous diuretics in an outpatient setting, but it is difficult to know when response will be adequate to avoid hospitalization. Hypothesis: We assessed whether a high initial Urine Sodium (Na) after an intravenous diuretic bolus would predict net Urine output > 1 liter after 3 hours of diuretic infusion, performed in an ACTIVE (Ambulatory Cardiac Triage, InterVention, and Education) unit where a nurse and pharmacist also provided heart failure education. Methods and Results: The unit accepted patients with chronic heart failure referred with symptomatic fluid overload without severe decompensation, and prescribed loop diuretic bolus and infusion dosed from an internal algorithm based on daily oral dose. Urine output was > 1 liter after 3 hours in 77% of patients with Urine Na response > 100 mmol/L, in 69% with Urine Na 61-100, and only 23% with initial Urine Na Conclusion: In conclusion, we can anticipate at least 1 liter diuresis in most patients with initial Urine Na > 60 mmol/L after bolus diuretic. Patients with Urine Na > 100 also have significantly lower 30 day ED and admission rates after outpatient diuretic infusion. Patients with low Urine Na response may still have diuresis but may need more prolonged intervention or revision of goals of care.
Joann Lindenfeld - One of the best experts on this subject based on the ideXlab platform.
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lower Urine Sodium predicts longer length of stay in acute heart failure patients insights from the rose ahf trial
Clinical Cardiology, 2020Co-Authors: Jonathan W Cunningham, Joann Lindenfeld, Lynne W Stevenson, Kevin J Anstrom, Michael M Givertz, Jielena Sun, Finnian Mc R Causland, Neal K LakdawalaAbstract:BACKGROUND In patients hospitalized with acute heart failure (AHF), low Urine Sodium concentration (UNa ) after diuretic treatment may identify patients at risk for longer length of stay (LOS) and adverse events. We investigated the prognostic significance of 24-hour cumulative postdiuretic Urine Sodium concentration in a multicenter clinical trial population. METHODS The Renal Optimization Strategies Evaluation AHF (ROSE AHF) trial randomized 360 patients with AHF and renal dysfunction receiving intravenous diuretic to dopamine, nesiritide, or placebo. Sodium concentration was measured in cumulative Urine sample collected during the first 24 hours after randomization in 298 patients. Based on prior studies, lower UNa was defined as ≤60 mmol/L. RESULTS Lower UNa was present in 142 (48%) patients, who had longer LOS (7 days vs 5 days, P < .001) and less 72-hour weight loss (5.7 lb vs 9.0 lb, P < .001). These associations persisted after controlling for baseline estimated glomerular filtration rate and outpatient furosemide dose. Lower UNa did not modify the null effects of dopamine or nesiritide on clinical outcomes. Results were similar for spot rather than cumulative 24-hour UNa concentration. CONCLUSION In patients hospitalized for AHF and renal dysfunction, UNa ≤ 60 mmol/L during the first 24 hours of diuresis identifies patients at risk for prolonged hospitalization but does not provide an indication for adjunctive dopamine or nesiritide.
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low Urine Sodium predicts length of stay but not response to dopamine or nesiritide in hospitalized patients with acute heart failure and renal dysfunction
Journal of the American College of Cardiology, 2019Co-Authors: Jonathan W Cunningham, Joann Lindenfeld, Lynne W Stevenson, Jie Sun, Kevin J Anstrom, Michael M Givertz, Neal K LakdawalaAbstract:In patients hospitalized with acute heart failure (AHF), low Urine Sodium (UNa) after diuretic may identify patients at risk for longer length of stay (LOS) and adverse events. We investigated whether patients with low UNa benefit from dopamine or nesiritide. The Renal Optimization Strategies
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first spot Urine Sodium after initial diuretic identifies patients at high risk for adverse outcome after heart failure hospitalization
American Heart Journal, 2018Co-Authors: Adriana Luk, Joann Lindenfeld, Akshay S Desai, Lynne W Stevenson, John D Groarke, Syed S Mahmood, Deepa M Gopal, Emer Joyce, Sachin P Shah, Neal K LakdawalaAbstract:Abstract Background Relief of congestion is the primary goal of initial therapy for acute decompensated heart failure (ADHF). Early measurement of Urine Sodium concentration (UNa) may be useful to identify patients with diminished response to diuretics. The aim of this study was to determine if the first spot UNa after diuretic initiation could select patients likely to require more intensive therapy during hospitalization. Methods At the time of admission, 103 patients with ADHF were identified prospectively, and UNa was measured after the first dose of intravenous diuretic. Clinical outcomes were compared for patients with UNa >60 mmol/L and UNa of ≤60 mmol/L, with the primary outcome of a composite of death at 90 days, mechanical circulatory support during admission, and requirement of inotropic support at discharge. Results Patients with UNa ≤60 had lower admission blood pressure, had less chronic neurohormonal antagonist prior to admission, and were more than twice as likely to experience the primary end point (hazard ratio 2.40, 95% CI 1.02-5.66, P = .045), which was marginally significant after adjusting for renal function and baseline home loop diuretic. Worsening renal function was significantly more common in patients with UNa 60. Conclusions Assessment of spot UNa after initial intravenous loop diuretic administration may facilitate identification and triage of a population of HF patients at increased risk for adverse events and prolonged hospitalization.
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spot Urine Sodium as triage for effective diuretic infusion in an ambulatory heart failure unit
Journal of Cardiac Failure, 2018Co-Authors: Marshall D Brinkley, Laura J Burpee, Sunitpreet Chaudhry, Jennifer A Smallwood, Joann Lindenfeld, Neal K Lakdawala, Akshay S Desai, Lynne W StevensonAbstract:Abstract Background Admission for diuresis remains a common and costly event in patients with advanced heart failure (HF). We tested whether spot Urine Sodium could identify patients likely to respond to ambulatory diuretic infusion without hospitalization. Methods and Results We prospectively followed 176 consecutive patients with advanced heart failure receiving intravenous furosemide for congestion in an ambulatory clinic. Spot Urine Sodium was measured in 1st voided Urine after diuretic infusion and compared with 3-hour Urine output and subsequent risk of 30-day hospitalization or emergency department (ED) visit. Spot Urine Sodium was significantly associated with Urine output in a model adjusted for age, renal function, and blood urea nitrogen (P = .02). Higher Urine Sodium was associated with lower risk of hospitalization or ED visit within 30 days (odds ratio [OR] 0.82 [95% confidence interval 0.72–0.94] per 10 mmol/L increase; P Conclusion High spot Urine Sodium after diuretic administration identifies HF patients likely to respond to an ambulatory diuretic infusion with lower rates of hospitalization or ED visits at 30 days.
Chienhsing Chang - One of the best experts on this subject based on the ideXlab platform.
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low dose oral desmopressin for nocturnal polyuria in patients with benign prostatic hyperplasia a double blind placebo controlled randomized study
The Journal of Urology, 2011Co-Authors: Chungjing Wang, Shiwei Huang, Chienhsing ChangAbstract:Purpose: We evaluated the long-term efficacy and safety of low dose oral desmopressin in elderly patients with benign prostatic hyperplasia with more than nocturnal voids and nocturnal polyuria more than 30% of total daily Urine volume.Materials and Methods: Eligible patients with benign prostatic hyperplasia older than 65 years with nocturia, nocturnal polyuria and International Prostate Symptom Score 14 or greater were included in the study. All patients received placebo or 0.1 mg desmopressin orally at bedtime. Patients were required to visit the outpatient clinic from the first visit, and after 1, 3, 6 and 12 months of treatment. Patients maintained flow volume charts and used diaries to record voiding data throughout the study. During followup urinalysis, Urine Sodium, Urine osmolality, serum electrolytes, prostate specific antigen, International Prostate Symptom Score, quality of life, transrectal ultrasonography of prostate, uroflowmetry and post-void residual Urine volume were performed at each vi...
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low dose oral desmopressin for nocturnal polyuria in patients with benign prostatic hyperplasia a double blind placebo controlled randomized study
The Journal of Urology, 2011Co-Authors: Chungjing Wang, Shiwei Huang, Yunan Lin, Chienhsing ChangAbstract:Purpose: We evaluated the long-term efficacy and safety of low dose oral desmopressin in elderly patients with benign prostatic hyperplasia with more than nocturnal voids and nocturnal polyuria more than 30% of total daily Urine volume.Materials and Methods: Eligible patients with benign prostatic hyperplasia older than 65 years with nocturia, nocturnal polyuria and International Prostate Symptom Score 14 or greater were included in the study. All patients received placebo or 0.1 mg desmopressin orally at bedtime. Patients were required to visit the outpatient clinic from the first visit, and after 1, 3, 6 and 12 months of treatment. Patients maintained flow volume charts and used diaries to record voiding data throughout the study. During followup urinalysis, Urine Sodium, Urine osmolality, serum electrolytes, prostate specific antigen, International Prostate Symptom Score, quality of life, transrectal ultrasonography of prostate, uroflowmetry and post-void residual Urine volume were performed at each vi...
Piotr Ponikowski - One of the best experts on this subject based on the ideXlab platform.
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renal profiling based on estimated glomerular filtration rate and spot Urine Sodium identifies high risk acute heart failure patients
European Journal of Heart Failure, 2021Co-Authors: Jan Biegus, Jeffrey M Testani, Robert Zymlinski, Ewa A Jankowska, Waldemar Banasiak, Dominik Marciniak, Agata Zdanowicz, Piotr PonikowskiAbstract:AIMS In acute heart failure (AHF), assessment of renal function comprises estimation of glomerular filtration rate (eGFR), which does not provide any information about renal Sodium/water handling. We describe the interactions between urinary Sodium concentration and eGFR to better characterize AHF patients. METHODS AND RESULTS In 219 patients with AHF, spot Urine Sodium (UNa+ ) and eGFR were assessed on admission, day 1 and day 2 of hospitalization. We found no correlation between UNa+ and eGFR (calculated on each consecutive day, as an average of all three values, and as changes from baseline; all P > 0.05). The population was subsequently divided into four profiles based on eGFR (preserved vs. impaired; cutoff of 60 mL/min/1.73 m2 ) and UNa+ (Sodium excreter vs. non-excreter; cutoff of 60 mmol/L). At day 1, there were 70 (31.9%) patients classified as preserved eGFR/Sodium excreter, 37 (16.8%) as impaired eGFR/Sodium non-excreter, 72 (32.9%) as impaired eGFR/Sodium excreter, and 40 (18%) as preserved eGFR/Sodium non-excreter. Both Sodium non-excreter profiles were associated with an increased risk of in-hospital heart failure worsening [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.3-6.4], inotrope use (OR 2.6, 95% CI 1.1-6.7) and rehospitalization due to AHF (OR 3.2, 95% CI 1.6-6.2; all P < 0.05). The preserved eGFR/Sodium non-excreter profile was associated with highest 1-year mortality (52.5%) and remained an independent prognosticator after adjustment for other prognosticators (hazard ratio 2.9, 95% CI 1.7-5.2; P < 0.0005). CONCLUSIONS In AHF, values of spot UNa+ and eGFR are not interrelated. Concomitant assessment of eGFR and spot UNa+ may be useful for better clinical and therapeutic profiling of patients.
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serial assessment of spot Urine Sodium predicts effectiveness of decongestion and outcome in patients with acute heart failure
European Journal of Heart Failure, 2019Co-Authors: Jan Biegus, Robert Zymlinski, Mateusz Sokolski, John Todd, Gad Cotter, Marco Metra, Ewa A Jankowska, Waldemar Banasiak, Piotr PonikowskiAbstract:AIMS The clinical significance of the measurement of Urine Sodium concentration (UNa+ ) in response to loop diuretic administration in patients with acute heart failure (AHF) is still unsettled. We studied the association of serial measurements of spot UNa+ during the first 48 h of AHF treatment with the indices of decongestion, renal function, and prognosis. METHODS AND RESULTS We enrolled 111 AHF patients, all of whom received intravenous furosemide on admission. The mean spot UNa+ significantly increased in the 6 h sample (P < 0.05 vs. baseline) and returned to baseline values in the 24 and 48 h samples. Based on the increase or decrease/no change of UNa+ in the 6 and 48 h samples vs. baseline, patients were divided into two groups at each time point, respectively. Patients did not differ in baseline clinical and laboratory characteristics. Patients with a decrease/no change of UNa+ in the 6 and 48 h samples had a lower weight loss during hospitalization. Patients with a decrease/no change of UNa+ in the 48 h sample had a poorer diuretic response and a significant increase in the urinary levels of the tubular biomarkers: kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin. Low UNa+ and decrease/no change in UNa+ in the 6 and 48 h samples were independent predictors of higher risk of all-cause mortality during 1-year follow-up (all P < 0.05). CONCLUSION In AHF, low spot UNa+ and lack to increase UNa+ in response to intravenous diuretics are associated with poor diuretic response, markers of tubular injury and high risk of 1-year mortality.