Urinary sodium-guided diuretic therapy in acute decompensated heart failure: A grade assessed systematic review and meta-analysis with trial sequential analysis

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2026-05-01 Epub Date: 2026-01-20 DOI:10.1016/j.cpcardiol.2026.103272

Ali Saad Al-Shammari , Khadeeja Ali Hamzah , Mahyar Masanabadi , Maryam Asif , Mehak Budhiraja , Nimra Shafi , Belal Mohamed Hamed , Yousif Hameed Kurmasha , Mohammedsadeq A. Shweliya , Yasar Sattar

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引用次数: 0

Abstract

Background

Diuretic resistance remains a major challenge in acute decompensated heart failure (ADHF). Urinary sodium (UNa) concentration provides an early marker of loop diuretic responsiveness, yet its clinical utility remains uncertain.

Methods

We conducted a systematic review and meta-analysis (PROSPERO ID: CRD420251175306). PubMed, Embase, Scopus, and CENTRAL were searched from database inception to October 1, 2025, for studies evaluating UNa-guided diuretic titration in hospitalized ADHF patients. Primary outcomes were 24- and 48 h diuresis and natriuresis; secondary outcomes included congestion relief, renal function, length of stay, rehospitalization, and mortality. Data were pooled using random-effects models. Heterogeneity was assessed using I² and χ² statistics. Analyses were performed with the R software (version 4.4.3, meta package). Certainty of evidence was rated using the GRADE framework.

Results

Five studies were included (three RCTs, two observational cohorts). UNa-guided therapy significantly increased 24- and 48 h diuresis (MD = 0.59,95%CI [0.30-0.87] L; MD = 0.70 [0.37-1.03] L) and natriuresis (MD = 88 [52-124] mmol; MD = 138 [69-206] mmol; all P < 0.001). No significant differences were observed in mortality (RR = 0.99 [0.60-1.63]), rehospitalization (RR = 0.90 [0.57-1.41]), renal dysfunction, or length of stay. Safety outcomes, including hypotension, hypokalemia, and renal worsening, were similar (all P > 0.05). Certainty of evidence was moderate for natriuresis/diuresis and low for clinical outcomes.

Conclusions

UNa-guided diuretic therapy enhances short-term natriuresis and diuresis without increasing adverse events but shows no proven impact on mortality, rehospitalization, or renal outcomes. Larger studies are needed to confirm its long-term benefit and feasibility.

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尿钠引导利尿剂治疗急性失代偿性心力衰竭：分级评估系统评价和荟萃分析与试验序贯分析。

背景：利尿剂抵抗仍然是急性失代偿性心力衰竭（ADHF）的主要挑战。尿钠（UNa）浓度提供了利尿剂循环反应的早期标志，但其临床应用仍不确定。方法：我们进行了系统评价和荟萃分析（PROSPERO ID: CRD420251175306）。检索PubMed、Embase、Scopus和CENTRAL数据库，从数据库建立到2025年10月1日，以评估una引导的住院ADHF患者利尿剂滴定的研究。主要结局为24小时和48小时利尿和尿钠；次要结局包括充血缓解、肾功能、住院时间、再住院和死亡率。使用随机效应模型汇总数据。采用I²和χ²统计量评估异质性。使用R软件（版本4.4.3，meta包）进行分析。使用GRADE框架对证据的确定性进行评级。结果：纳入5项研究（3项随机对照试验，2项观察性队列）。ua引导治疗可显著提高24小时和48小时利尿（MD = 0.59,95%CI [0.30-0.87] L; MD = 0.70 [0.37-1.03]L）和钠尿（MD = 88 [52-124]mmol; MD = 138 [69-206]mmol， P均< 0.001）。两组患者的死亡率（RR = 0.99[0.60-1.63]）、再住院率（RR = 0.90[0.57-1.41]）、肾功能不全、住院时间均无显著差异。安全性结果，包括低血压、低钾血症和肾脏恶化，相似（均P < 0.05）。钠尿/利尿的证据确定性中等，临床结果的证据确定性较低。结论：una引导的利尿剂治疗可以增强短期尿钠和利尿，而不会增加不良事件，但对死亡率、再住院或肾脏预后没有证实的影响。需要更大规模的研究来证实其长期效益和可行性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.