Improving Treatment for Acute Heart Failure: Urine Salt Test Leads to Faster Recovery and Lower Mortality Rates

By measuring the salt content in the urine and adjusting the urinary medication of patients with acute heart failure, they can lose fluid more easily. They die less often in hospital and recover more quickly than patients without this test. The University Medical Center Groningen immediately introduced the treatment.

Acute heart failure in the Netherlands leads to hospitalization 30,000 times a year. The heart pumps the blood around less well, so that patients retain a lot of fluid, also behind the lungs, making them very short of breath. The only treatment is symptomatic treatment: diuretics to get rid of fluids. “But this does not work well in half of the patients, for example because the kidneys are already used to medication and do everything they can to retain salt,” says UMCG cardiologist Jozine ter Maaten. She led the survey this week Nature popped up.

To determine the dose of diuretic medication, up to now, the kidney function and whether a patient is already using diuretics was looked at during admission. The balance is precarious: too high a dose can damage the kidneys. To predict how patients respond to medication, Ter Maaten went back to basics. “In essence, medicines do not work on moisture, but they encourage the kidneys to excrete salt: the fluid goes along with it. The salt content in the urine therefore says something about the response of the kidneys to the medication.”

‘Aggressive’ treatment

310 patients participated in the study. From two hours after the first infusion of diuretics (bumetanide and furosemide), nurses took urine from the test group every six hours – instead of checking after a day whether the patient had lost weight. If the lab found a low salt level (at 85 percent), patients immediately received the “aggressive” treatment: first a higher dose of bumetanide/furosemide, and if that did not work enough, an additional drug that activates another part of the kidneys.

“It was striking that it differed greatly per person after how many hours a salt deficiency was measured.” Not only fast measurement is therefore important, too more often to measure. In the control group, the medication was sometimes also increased, but usually only after a day. “There is a risk that the kidneys have already adapted and no longer respond well to a higher dose.”

The patients in the ‘salt group’ lost fluid more quickly and spent an average of one day shorter in hospital (6 versus 7 in the control group). And while 14 people out of 160 in the control group died during the admission, that was no more than 2 out of 150 in the salt group. “Important”, emphasizes Ter Maaten, “the kidney function did not deteriorate. So the treatment is safe.”

At the UMCG, all patients with heart failure are now given the salt test. Ter Maaten expects other hospitals to follow soon. “The guideline was already to measure the response to water medication more quickly. Now we also have the handles. And a simple sodium test costs less than a euro.”

After six months, there was no longer any effect in the salt group. “This group was too small to measure that.”

A version of this article also appeared in the newspaper on August 30, 2023.
2023-08-29 11:39:59
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