BÀI XUẤT NATRI NIỆU MỘT THỜI ĐIỂM TRONG ĐÁNH GIÁ ĐÁP ỨNG LỢI TIỂU QUAI Ở BỆNH NHÂN SUY TIM CẤP

Abstract

Introduction: 20-30% of patients with acute heart failure (AHF) are found to be diuretic resistant, which limits the effectiveness of decongestive therapy, thereby increasing the risk of cardiovascular events. The response to loop diuretics is challenging to assess in practice, recent studies have shown the useful role of spot urinary sodium excretion markers in the assessment of diuretic response at very early stages. Objectives: We aim to describe the characteristics of spot urinary sodium excretion after loop diuretic treatment and determine the relationship between thesse markers with clinical measurements in assessing loop diuretic response of AHF patients. Methods: A retrospective descriptive cross-sectional study was performed on 51 AHF patients admitted to Cardiology Department - Cho Ray Hospital from 09/2020 to 12/2021. Wer recorded the results of spot urinary sodium concentration and fractional excretion of sodium after loop diuretic treatment; and clinical scales including weight loss, urine output, and net fluid loss after 24 hours of diuretic treatment. Results: With a median initial dose of 20 (20-40) mg intravenous furosemide treatment; median spot urinary sodium concentration and fractional excretion of sodium were 104 (70 – 123) mmol/L and 2.62 (0.97 – 7.58)%, respectively. Both urinary sodium concentration and fractional excretion of sodium were moderately positively correlated - statistically significant with the clinical scales: weight loss, urine output, and net fluid loss after 24 hours with initial loop diuretic treatment. The group with low urinary sodium concentration (≤ 60 mmol/L) had a significantly worse response to loop diuretics than the group with high urinary sodium concentration (> 60 mmol/L). Conclusion: Low spot urinary sodium excretion is associated with poor loop diuretic response; demonstrated by significantly lower weight loss, urine ouput and net fluid loss after diuretic treatment.