Urinary biomarkers in different diuretic response groups with heart failure

Abstract

Abstract Purpose Predicting diuretic response in different hemodynamic profiles is challenging in heart failure patients. Worsening renal function with diuretic therapy leads to decision making more difficult. Spot urinary sodium is an important milestone to determine decongestion therapy intensity. Serum biomarkers are widely used for diagnosis and follow up but more urinary biomarkers can be identified for risk stratification. Methods We enrolled 61 patients with decompansated heart failure on the first day of admission. Baseline characteristics and urinary biomarkers were recorded. Diuretic response was classified as good or poor response groups according to spot urine sodium within second hour after first intravenous diuretic administration. Quantitative variables were specified as mean ± standard deviation, categorical variables were specified as frequency and percentage. Mean differences were assessed with Student-T test and Welch test. Statistically significant parameters were also assessed with logistic regression analysis. Results Only U/P creatinine ratio and urine creatinine were statistically lower in good diuretic response group (p<0.0001). Fractional excretion of urea and potassium were higher in good response group (p<0.0001 and p<0.005). Urinary sodium to potassium ratio, UNa/UCr and UK/UCr are also statistically higher in the good response group (p<0.0001). Sodium associated parameters (UNa/UK, UNa/UCr) and urinary creatinine were also significant in logistic regression. Discussion Urinary biomarkers are not well defined parameters in heart failure patients but these parameters may be more dynamic than serum parameters as spot urine sodium. Our data indicates that poor response group has a more prerenal phenotype than good response group.Table 1.Urine biomarker definitionsTable 2.Results