Urine sodium concentration after intravenous furosemide in dogs with acute congestive heart failure and correlation with treatment efficacy
Victoria ConveyTerry HuhErin J. AchillesLaura K. MasseyVictoria F. McKabaKerry A. LoughranMarc S. KrausAnna R. GelzerAlexandra CrooksMark A. Oyama
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Abstract Background Poor natriuresis is a potential marker of diuretic resistance in dogs with acute congestive heart failure (CHF) but little is known about the relationship between urine sodium concentration (uNa) and frequency of successful decongestion. Supplemental O 2 is a common treatment in dogs with severe CHF. The time from start to discontinuation of supplemental O 2 therapy (DCSO 2 ) typically reflects the time course and ease of decongestion. Hypothesis/Objectives Urine Na concentration after IV administration of furosemide will be correlated with duration of treatment with supplemental O 2 (time O2 ) and the cumulative frequency of successful DCSO 2 during hospitalization. Animals Fifty‐one dogs with acute CHF. Methods Retrospective observational single center study. Results Dogs with low uNa had significantly longer mean time O2 than dogs with high uNa (uNa <87 mmol/L, 24.2 ± 2.6 hours vs uNa ≥87 mmol/L, 16.6 ± 1.7 hours; P = .02). Low uNa was correlated with lower cumulative frequency of DCSO 2 (12 hour, 28%; 24 hour, 42%; 36 hour, 73%) compared to high uNa (12 hour, 28%; 24 hour, 88%; 36 hour, 96%; P = .005). History of PO loop diuretics, low serum chloride concentration (sCl), and high PCV were associated with low uNa. Urine Na concentration outperformed other metrics of diuretic responsiveness including weight loss. Conclusions and Clinical Importance Urine Na concentration after IV furosemide predicted time O2 and cumulative frequency of DCSO 2 in dogs with acute CHF, which likely reflects important aspects of diuretic responsiveness. Urine Na can assess diuretic responsiveness and treatment efficacy in dogs with CHF.Keywords:
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BACKGROUND AND OBJECTIVES Urine calcium correlates with urine sodium. The aims of this study were to investigate whether the urine sodium–calcium relationship persists into old age and whether it holds after adjustment for urine magnesium. DESIGN Cross‐sectional descriptive analysis. PATIENTS Residents of two aged care institutions (median age 84 years) who were not taking diuretics, calcium or vitamin D supplements. MEASUREMENTS Early morning urine calcium, sodium and magnesium, plasma creatinine and serum 25‐hydroxyvitamin D and parathyroid hormone. RESULTS Urine calcium correlated with urine sodium (r = 0.29, P < 0.01) and with urine magnesium (r = 0.56, P < 0.001). After adjustment for urine magnesium, the relationship between urine sodium and urine calcium was no longer significant. Forty‐five percent of the interindividual variation in urine calcium was explained by a linear model on the basis of urine magnesium and plasma creatinine. CONCLUSION The data indicate that a correlation between urine sodium and calcium persists in very old age. However, this correlation no longer holds after adjustment for urine magnesium. Further studies examining urine calcium excretion should also consider urine magnesium.
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Abstract Background and Aims In daily clinical practice, individual-level sodium (Na) intake is often estimated by measuring Na excretion in a single 24h urine collection, but long-term Na balance studies indicate that 7 consecutive 24h urine collections are needed. However, this approach is not feasible in clinical settings. In this study, we investigate whether the use of repeated spot urine sampling is an appropriate alternative for repeated 24h urine collections. Method We performed a post-hoc analysis of a metabolic ward study in 8 healthy male adults who consumed a 7-day diet with a fixed amount of Na (200 mmol/d). Urine was collected in four daily intervals: 7-13h, 13-19h, 19-23h and 23-7h. After reaching steady state, we estimated Na intake with 1 and 3 consecutive 24h urine collections and 3-day spot urine sampling, using the Kawasaki formula with measured 24h urine creatinine excretion. Results: On day 5, mean 24h Na excretion matched intake, indicating that steady state was achieved (Fig A). Mean and standard deviation of absolute differences between estimated and measured Na intake (ΔNa) for each method were: 18.8 ±14.6 mmol (3 x spot urine 7-13h), 32.3 ±18.7 mmol (3 x spot urine 13-19h), 74.6 ±30.0 mmol (3 x spot urine 19-23h), 28.2 ±19.8 mmol (3 x spot urine 23-7h), 29.8 ±23.9 mmol (1 x 24h urine) and 22.9 ±11.3 mmol (3 x 24h urine) (Fig B). With the exception of the 19-23h spot urine collection period, the accuracy of 3-day spot urine sampling did not significantly differ from accuracy of 1 and 3 consecutive 24h urine collections. When combining the pre-night and morning spot urine collections (19-7h), the accuracy of the estimation did not improve (ΔNa 28.7 ±19.6 mmol). Conclusion 3-day spot urine sampling did not perform significantly different than 1 and 3 24h urine collections for estimation of individual-level Na intake. Adequately powered studies need to confirm whether repeated spot urine sampling is an accurate and low burden alternative to repeated 24h urine collections.
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Background: Generally, eating salty food items increases thirst. Thirst is also stimulated by the experimental infusion of hypertonic saline. But, in steady state, does the kidney need a higher amount of water to excrete sodium on a high than on a low sodium intake? This issue is still controversial. The purpose of this review is to provide examples of how the kidney handles water in relation to salt intake/output. It is based on re-analysis of previously published studies in which salt intake was adjusted to several different levels in the same subjects, and in databases of epidemiologic studies in populations on an ad libitum diet. Summary and Key Messages: These re-analyses allow us to draw the following conclusions: (1) In a steady state situation, the urine volume (and thus the fluid intake) remains unchanged over a large range of sodium intakes. The adaptation to a higher sodium excretion rests only on changes in urinary sodium concentration. However, above a certain limit, this concentration cannot increase further and the urine volume may then increase. (2) In population studies, it is not legitimate to assume that sodium is responsible for changes in urine volume, since people who eat more sodium also eat more of other nutrients leading to an increase in the excretion of potassium, urea and other solutes, besides sodium. (3) After an abrupt increase in sodium intake, fluid intake is increased in the first few days, but urine volume does not change. The extra fluid drunk is responsible for an increase in body weight.
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The 24-hr urine sodium excretion level was estimated based on the spot urine sodium, and the efficacy of the formula was validated to determine the status of low salt intake <100 mEq Na/day. The 24-hr urine samples were collected from 400 patients. The 24-hr urine creatinine level was estimated with the use of three formulas: a newly derived Korean equation (E24UCR_K), and Tanaka (E24UCR_T) and Cockcroft-Gault (E24UCR_CG) equations. The correlation coefficients between the estimated and measured 24-hr urine creatinine for these three equations were 0.863, 0.846, and 0.896, respectively (All P<0.001). After estimating the 24-hr urine sodium levels, the correlation coefficients between the estimated and measured 24-hr urine sodium levels were 0.466, 0.490, and 0.516, respectively (All P<0.001). The sensitivity of three formulas to estimate the measured 24-hr urine sodium≥100 mEq/day using the estimated amount≥100 mEq/day was 84.3%, 87.6%, and 84.8%, respectively. In conclusion, the three equations used to estimate the 24-hr urine sodium content were useful to determine the status of low salt intake.
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Objective: High sodium intake is associated with an increased risk of cardiovascular disease, whereas a high potassium intake is associated with a reduced risk. Dietary counselling requires accurate estimation of sodium and potassium intake, but 24-hour urine sodium and potassium excretion demonstrated not to reflect actual intake. Urine sodium-to-potassium (Na/K) ratio is a promising alternative as it may be less affected by aldosterone-induced rhythmic changes in total body sodium and potassium content, is less influenced by incomplete urine collections, and incorporates both the effect of sodium and potassium. Our study assesses whether 24-hour urine Na/K ratio is superior in predicting dietary intake compared to 24-hour urine sodium or potassium excretion. Design and method: A post-hoc analysis was performed on data from the long-term sodium balance studies Mars105 and Mars520. Ten healthy participants received a diet with a known sodium and potassium content and collected 24-hour urine samples for 105 or 205 days. We calculated the log fold difference between dietary intake and urine content of sodium, potassium and Na/K ratio. We compared these estimates of accuracy using a mixed-effects model with a random intercept per subject. We analysed whether the accuracy differed among 6, 9 and 12 grams salt intake or was affected by the number of 24-hour urine collections. Results: Urine Na/K ratio underestimated dietary Na/K ratio with a median difference of -0.21 (IQR -0.47 to 0.09). Compared to sodium and potassium assessment, the Na/K ratio was significantly less accurate in predicting intake (Figure 1A). Only for the 6 gram salt phase the Na/K ratio did not perform significantly worse than sodium measurements. Increasing the number of 24-hour urine measurements to three or seven improved accuracy of the Na/K ratio, although it remained inferior to separate assessment of sodium and potassium excretion (Figure 1B). Conclusions: The 24-hour urine Na/K ratio is less accurate than 24-hour urine sodium excretion for estimation of dietary intake in a controlled setting.
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Objective To observe the effect using furosemide through intravenous injection and intravenous on the treatment of acute heart failure.Methods 40 patients with the cardiac function NYHA Ⅳ grade were randomly divided into the intravenous injection furosemide group and the intravenous furosemide group,were evaluated the indices of kidney function,and urine volume etc.Results The urine volume of intravenous group is more than intravenous injection group,kidney function and sodium has no obvious differences.Conclusion The treatment of intravenous furosemide on heart failure of diuretic effect is better than intravenous injection furosemide.
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The purpose of this study was to determine which urine electrolytes should be measured to confirm that the extracellular fluid (ECF) volume is depleted. ECF volume contraction was induced by furosemide administration to rats consuming an electrolyte-free diet. An external potassium balance was achieved by replacing potassium losses with KHCO3 and KC1 so that the sodium and chloride deficits were comparable (equivalent to a 30% reduction in ECF volume). As expected, the urine sodium and chloride concentrations fell to 2 ± 0.3 mmol/l and 3 ± 0.3 mmol/l, respectively. Rats were then randomized to receive 50–75% of their sodium or chloride deficit as either: NaCl (control group), NH4Cl or NaHCO3 to mimic clinical situations associated with ECF volume contraction. In the NaCl group, the urine sodium and chloride concentrations remained low (6 ± 2 mmol/l and 7 ± 2 mmol/l), consistent with persistent ECF volume contraction. Although the NH4C1 group continued to have a low urine sodium concentration (2 ± 0.2 mmol/l), there was now a marked increase in the urine chloride concentration (51 ± 7 mmol/l; p < 0.01 vs. NaCl group). In contrast, although the NaHC03 group continued to have a low urine chloride concentration (2 ± 1 mmol/l), there was a significant increase in the urine sodium concentration (19 ± 3 mmol/l; p < 0.01 vs. NaCl group). We conclude that the clinical assessment of ECF volume by urine electrolytes requires an evaluation of both the urine sodium and chloride concentrations.
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Objective Observe the clinical curative effective and security on continuous intravenous infusion of high-dose furosemide in Severe heart failure.Methods 60 Severe heart failure patients were randomly divided into the remedial group and the control group,30 cases in each.The treatment group was given intravenous injection of furosemide plus continuous intravenous infusion of furosemide,and the control group received intravenous injection of furosemide 2 times a day,the effectiveness of treatment was observed before and after remedy.Results Compared with those before treatment,the edema subsided and shortness of breath showed virtually identical improvement,low blood pressure and low potassium in treatment group,Patients in the remedy group had a shorter hospital stay period than control group.Conclusion High-dose furosemide continuous intravenous pump is a safety and effective method in Severe heart failure,and could shorten the period of hospitalization.
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