What question did this study set out to answer?

To investigate how pre- and post-diuretic urine and serum osmolarity affect outcomes in acute heart failure patients.

January 10, 2026Kardiologia Polska0 citationsOpen Access

The impact of pre- and post-diuretic urine osmolarity and serum osmolarity on one-year outcomes in acute heart failure patients during early decongestion

MGMateusz GuzikUniversity of Wrocław MGMateusz GarusWroclaw Medical University GIGracjan IwanekUniversity of Wrocław

Key Points

To investigate how pre- and post-diuretic urine and serum osmolarity affect outcomes in acute heart failure patients.
Conducted an observational study on heart failure patients undergoing diuretic treatment

Structured PICO

Does pre- and post-diuretic urine osmolarity predict all-cause death and unplanned rehospitalization in patients with acute heart failure?

Population

262 adults with acute heart failure (AHF) presenting with symptoms and signs of congestion, NT-proBNP >2000 pg/ml, admitted within 48 hours. Mean age 68, 70% male. Single-center in Poland.

Intervention

Measurement of pre- and post-diuretic urine and serum osmolarity during early decongestion with intravenous loop diuretics (median dose 60 mg furosemide equivalent).

Outcome

Two distinct outcomes evaluated separately: 1) all-cause death and 2) all-cause unplanned rehospitalization at one-year follow-up.hard clinical

Higher pre-diuretic urine osmolarity and a greater decrease during early decongestion are associated with improved one-year survival and fewer rehospitalizations in acute heart failure patients.

Abstract

BACKGROUND: Osmolarity is a key indicator of the balance between water and osmotically active molecules. It plays a crucial role in the diuretic response among patients with congestion in acute heart failure (AHF), and therefore, it may provide clinically meaningful information. AIMS: This study investigated the association between urine (pre- and post-diuretic) and serum osmolarity during early diuretic treatment and one-year outcomes in AHF patients. METHODS: It was single-center, prospective, observational study that included AHF. The patients were recruited between March 2021 and November 2023 and underwent one-year follow-up. Serum and urine osmolarity and their contributors (sodium, urea, glucose) were measured before loop diuretic exposure and 3 hours after infusion start. The main endpoints included: 1) all-cause mortality and 2) all-cause unplanned rehospitalizations. RESULTS: In a one-year follow-up, 59 (23%) patients died (26 10% during index hospitalization), and 95 (40%) were rehospitalized. Higher pre-diuretic urine osmolarity was independently associated with a lower probability for mortality (hazard ratio HR, 0.95; 95% confidence interval CI, 0.93-0.98; P <0.01) and rehospitalization (HR, 0.98; 95% CI, 0.95-0.99; P = 0.03). Pre-diuretic urine osmolarity was significantly lower in patients with an event during follow-up (359 272-403 vs. 419 332-509 mOsm/l; P <0.001 for mortality and 384 303-463 vs. 430 342-524 mOsm/l; P = 0.03 for rehospitalization). Moreover, the degree of urine osmolarity drop was lower in patients who died (32 8-77 vs. 122 50-208 mOsm/l; P <0.001) and significantly influenced death probability (0.93 0.89-0.97; P <0.01), while significance was not proven regarding rehospitalizations (0.98 0.95-1.00; P = 0.16). Serum and post-diuretic urine osmolarity had no prognostic significance. CONCLUSIONS: Pre-diuretic urine osmolarity and the degree of its decrease (reflecting the potential for urine dilution) during early decongestion are associated with one-year outcomes in AHF.

Ask AI

Helpful

Bookmark

View Full Paper