Predicted natriuretic output and cardiorenal phenotyping in hospitalised heart failure
S Castro, S Singh, M Elajami, J Callaghan, M Khan, M Boisjoli-Langlois, S Arora, J Radojevic, A Jaiswal, G SinghAbstract
Background
Effective decongestion in hospitalised heart failure (HF) is frequently limited by variable natriuretic response and concern for kidney injury. Whether predicted natriuretic output can identify distinct biological cardiorenal phenotypes in routine clinical practice remains uncertain.
Purpose
Determine whether predicted natriuretic output stratifies hospitalised HF patients into distinct renal and decongestion phenotypes within a protocolised diuretic strategy.
Methods
A retrospective analysis of consecutive HF admissions managed using a pharmacy-driven, natriuresis-guided diuretic protocol at a tertiary care centre. Predicted natriuretic output was calculated using a validated natriuretic prediction equation. Patients were stratified by highest predicted sodium output during hospitalisation (≥100meq vs <100meq). Outcomes included acute kidney injury (AKI; KDIGO criteria), urine sodium concentration, and decongestion markers. Associations between baseline creatinine and predicted natriuretic output were assessed using Spearman correlation, and logistic regression was used to identify predictors of poor natriuretic response.
Results
Among patients with available natriuretic data (N = 145), 78 (53.8%) had predicted natriuretic output <100 and 67 (46.2%) ≥100 mEq. Patients with lower predicted natriuretic output had worse baseline renal function (median creatinine ~1.4 vs ~1.0 mg/dL) and higher rates of AKI (approximately 35% vs 15%). Baseline creatinine was inversely correlated with predicted natriuretic output (Spearman ρ ≈ −0.38, p < 0.001). In logistic regression analysis, baseline creatinine independently predicted poor natriuretic response (odds ratio ≈8 per 1 mg/dL increase; p < 0.001). Higher predicted natriuretic output was associated with greater urine sodium concentrations and more effective natriuresis.
Conclusion(s)
Predicted natriuretic output identifies distinct renal and decongestion phenotypes in hospitalised HF. Poor natriuretic response is strongly associated with impaired baseline renal function, whereas higher natriuretic output reflects preserved natriuretic capacity. Incorporation of predicted natriuretic output into diuretic strategies may facilitate an early phenotyping and individualised decongestive care.