Key result
Reprieve System increases 24-hour natriuresis ~156% vs optimal diuretic therapy in acute heart failure.
Why the study?
The Reprieve System is designed to overcome barriers limiting safe and rapid decongestion, and this study aimed to establish proof-of-concept that it can facilitate rapid and safe decongestion.
Does the Reprieve System improve 24-hour natriuresis and safely facilitate rapid decongestion in hospitalized patients with acute heart failure compared to optimal diuretic therapy?
RCT
randomized
Does the Reprieve System improve 24-hour natriuresis and safely facilitate rapid decongestion in hospitalized patients with acute heart failure compared to optimal diuretic therapy?
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“By continuously quantifying urine output and intermittently measuring sodium excretion, the system targets the most relevant physiological endpoint in [acute HF] – natriuresis – and translates it into real-time therapeutic adjustments. This directly addresses one of the central weaknesses of curr...”
The Reprieve System safely produced significantly faster decongestion and greater 24-hour natriuresis compared with optimal diuretic therapy in patients with acute heart failure.
BACKGROUND: The Reprieve System is designed to overcome barriers limiting safe and rapid decongestion with individualized automated diuretic titration, real-time diuretic response monitoring, and individualized sodium chloride replacement to prevent cardio-renal dysfunction. OBJECTIVES: This study aims to establish proof-of-concept that the Reprieve System can facilitate rapid and safe decongestion. METHODS: FASTR (Fluid Management of Acute Decompensated Heart Failure Subjects Treated With Reprieve Decongestion Management System [DMS]) was a randomized pilot trial comparing the Reprieve System vs a control strategy of optimal diuretic therapy (ODT) in hospitalized patients with acute heart failure. The primary efficacy endpoint was 24-hour natriuresis, and the primary safety endpoint was a composite of dialysis or doubling of creatinine levels, severe electrolyte abnormalities, hypotension, or hypertensive emergency. RESULTS: ) with estimated excess fluid volume of 20 lbs (Q1-Q3: 15-35 lbs). Twenty-four-hour natriuresis was significantly greater with the Reprieve System (1,082 ± 487 mmol) vs ODT (423 ± 290 mmol; P < 0.001). The safety endpoint occurred in 31% of the Reprieve group vs 39% of the ODT group (P = 0.42). Intravenous diuretic therapy duration was shorter with Reprieve [46 hours [Q1-Q3: 29-80 hours]) vs ODT (88 hours [Q1-Q3: 44-143 hours]; P = 0.014). The rate of weight loss (P = 0.002), net fluid loss (P = 0.03), and net natriuresis (P < 0.001) were significantly faster with Reprieve. Change in serum creatinine levels did not differ between the Reprieve (0.19 ± 0.24 mg/dL) and ODT (0.31 ± 0.39 mg/dL; P = 0.07) groups. CONCLUSIONS: In this pilot trial, the Reprieve System safely produced significantly faster decongestion compared with ODT. Confirmation of these findings in the ongoing pivotal trial is required. (Fluid Management of Acute Decompensated Heart Failure Subjects Treated With Reprieve Decongestion Management System [DMS] [FASTR]; NCT05174312).
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Udelson et al. (2026) conducted an RCT in acute heart failure. Reprieve System vs. optimal diuretic therapy (ODT) was evaluated on 24-hour natriuresis (p=<0.001). The Reprieve System significantly increased 24-hour natriuresis compared with optimal diuretic therapy (1,082 vs 423 mmol; P<0.001) in hospitalized patients with acute heart failure.
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