Spot Urinary Sodium as a Biomarker of Diuretic Response in Acute Heart Failure

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  Figure 1. Guided diuretic therapy according to early post‐diuretic spot urinary sodium in acute heart failure. In AHF, the kidneys shows higher avidity of sodium reabsorption, and consequently low urinary sodium is frequently present and associated with more severe disease. Excluding cirrhotic, in fluid overload patients with AHF, a spot UNa <50 mEq/L at 2 hours after loop diuretic infusion is associated with worse loop diuretic response (diuretic resistance) using different metrics. Expert consensus recommends early intensification of diuretic therapy in case of low UNa (<50–70 mEq/L) at 2 hours after the first intravenous loop diuretic administration. We propose a comprehensive interpretation of early UNa after diuretic treatment accounting for other parameters of decongestion, especially in specific cases in which the evidence is scarce and pathophysiology of UNa complex, such as ambiguity about volume overload status, AKI, severe CKD, cirrhotic patients, and use of aquaretics. Equally as ESC guidelines declare and because most studies are observational and use different cutoffs from 50 to 89 mmol, the cutoff used in this figure is based on expert opinion and based in recent released…