ARYA Atherosclerosis Journal

Can fractional excretion of sodium predict worsening of renal function, in-hospital mortality, and length of hospital stay in acute decompensated heart failure?

Document Type : Original Article(s)

Authors

Farzaneh Ahmadi 1
Ekhlas Torfi 1
Sayed Mohammadreza Afshani 1
Saadat Kazemi-Mansourabad 2
Fatemeh Hayati 3

1 Assistant Professor, Department of Cardiovascular Disease, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Cardiologist, Department of Cardiovascular Disease, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 Assistant Professor, Chronic Renal Failure Research Center, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

https://doi.org/10.22122/arya.v17i0.2292
Abstract
BACKGROUND: Fractional excretion of sodium (FENa), the reflection of sodium (Na) handling by the kidney during natriuresis, is influenced by exo- and endogenous factors that have a powerful impact on renal function. We performed this study to define the correlation between FENa and worsening renal function (WRF) and assess the value of FENa in the length of hospital stay and in-hospital mortality in the patients with acute decompensated heart failure (ADHF).
METHODS: This prospective observational study was performed in two tertiary governmental heart centers located in Ahvaz, Iran, from March 2019 to March 2020. Any individual suffering from ADHF who had no renal failure, received only loop diuretics, and was on a low Na diet was eligible for recruitment in this study. The urine sample used to calculate FENa was a 24-hour sample.
RESULTS: Over the one year, 56 patients met the inclusion criteria. The total study population had a mean age of 61.46 ± 14.22 years with the dominance of women (51.8%). The mean age of men and women was 58.59 ± 14.35 and 64.13 ± 13.80 years, respectively. During hospitalization, 13 (23.2%) patients experienced WRF. In patients who experienced WRF during hospitalization, FENa of < 1% was mostly observed compared to FENa of 1%-2% (42.9% vs. 0%, P < 0.05). Post-hoc test of data on mean hospitalization days indicated that those with lower FENa had longer admission periods than those with other FENa groups (< 1%: 3.04 ± 1.02 days vs. 1%-2%: 1.58 ± 0.66 days, P < 0.001 and < 1%: 3.04 ± 1.02 days vs. > 2%: 2.30 ± 0.92 days, P = 0.02). There was no significant relation in terms of in-hospital death across different categories of FENa (P = 0.69).
CONCLUSION: Our data suggested that FENa less than 1% was associated with WRF and could be associated with a longer hospitalization period. We did not find any association between FENa and in-hospital mortality. Further studies with a larger number of patients are required to determine the cut-off value.

Keywords

Sodium
Heart Failure
Kidney
Hospitalization
  1. Givi M, Heshmat-Ghahdarijani K, Garakyaraghi M, Yadegarfar G, Vakhshoori M, Heidarpour M, et al. Design and methodology of heart failure registry: Results of the Persian registry of cardiovascular disease. ARYA Atheroscler 2019; 15(5): 228-32.
  2. Omar HR, Guglin M. Higher diuretic requirements in acute heart failure with admission hyponatraemia versus normonatraemia. Heart Lung Circ 2020; 29(2): 233-41.
  3. Formiga F, Moreno-Gonzalez R, Chivite D, Casado J, Escrihuela-Vidal F, Corbella X. Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization. Rev Port Cardiol (Engl Ed) 2018; 37(2): 159-65.
  4. Mogensen UM, Ersboll M, Andersen M, Andersson C, Hassager C, Torp-Pedersen C, et al. Clinical characteristics and major comorbidities in heart failure patients more than 85 years of age compared with younger age groups. Eur J Heart Fail 2011; 13(11): 1216-23.
  5. Damman K, Voors AA, Navis G, van Veldhuisen DJ, Hillege HL. The cardiorenal syndrome in heart failure. Prog Cardiovasc Dis 2011; 54(2): 144-53.
  6. Ronco C, Bellasi A, Di Lullo L. Cardiorenal syndrome: An overview. Adv Chronic Kidney Dis 2018; 25(5): 382-90.
  7. Eshaghian S, Horwich TB, Fonarow GC. Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol 2006; 97(12): 1759-64.
  8. Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B. The severe cardiorenal syndrome: 'Guyton revisited'. Eur Heart J 2005; 26(1): 11-7.
  9. Kumar D, Bagarhatta R. Fractional excretion of sodium and its association with prognosis of decompensated heart failure patients. J Clin Diagn Res 2015; 9(4): OC01-OC03.
  10. Shlipak MG, Massie BM. The clinical challenge of cardiorenal syndrome. Circulation 2004; 110(12): 1514-7.
  11. Lofman I, Szummer K, Evans M, Carrero JJ, Lund LH, Jernberg T. Incidence of, associations with and prognostic impact of worsening renal function in heart failure with different ejection fraction categories. Am J Cardiol 2019; 124(10): 1575-83.
  12. Torfi E, Naderi N, Taghavi S, Omidi S, Amin A. Predicting the in-hospital outcome in acute heart failure: Role of laboratory tests. Iran Heart J 2019; 20(3): 60-5.
  13. Volpe M, Magri P, Rao MA, Cangianiello S, DeNicola L, Mele AF, et al. Intrarenal determinants of sodium retention in mild heart failure: effects of angiotensin-converting enzyme inhibition. Hypertension 1997; 30(2 Pt 1): 168-76.
  14. Gabrielsen A, Bie P, Holstein-Rathlou NH, Christensen NJ, Warberg J, Dige-Petersen H, et al. Neuroendocrine and renal effects of intravascular volume expansion in compensated heart failure. Am J Physiol Regul Integr Comp Physiol 2001; 281(2): R459-R467.
  15. Fifer MA, Molina CR, Quiroz AC, Giles TD, Herrmann HC, De Scheerder IR, et al. Hemodynamic and renal effects of atrial natriuretic peptide in congestive heart failure. Am J Cardiol 1990; 65(3): 211-6.
  16. Dormans TP, Gerlag PG. Combination of high-dose furosemide and hydrochlorothiazide in the treatment of refractory congestive heart failure. Eur Heart J 1996; 17(12): 1867-74.
  17. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74(10): e177-e232.
  18. Hammarlund MM, Paalzow LK, Odlind B. Pharmacokinetics of furosemide in man after intravenous and oral administration. Application of moment analysis. Eur J Clin Pharmacol 1984; 26(2): 197-207.
  19. Casu G, Merella P. Diuretic therapy in heart failure - current approaches. Eur Cardiol 2015; 10(1): 42-7.
  20. Brater DC. Clinical pharmacology of loop diuretics in health and disease. Eur Heart J 1992; 13(Suppl G): 10-4.
  21. Kaplan AA, Kohn OF. Fractional excretion of urea as a guide to renal dysfunction. Am J Nephrol 1992; 12(1-2): 49-54.
  22. Ellison DH. Clinical pharmacology in diuretic use. Clin J Am Soc Nephrol 2019; 14(8): 1248-57.
  23. Hasenfuss G, Holubarsch C, Herzog C, Knauf H, Spahn H, Mutschler E, et al. Influence of cardiac function on the diuretic and hemodynamic effects of the loop diuretic piretanide. Clin Cardiol 1987; 10(2): 83-8.
  24. Alattar FT, Imran N, Debari VA, Mallah KN, Shamoon FE. Fractional excretion of sodium predicts worsening renal function in acute decompensated heart failure. Exp Clin Cardiol 2010; 15(3): e65-e69.
  25. Verbrugge FH, Mullens W, Malbrain M. Worsening renal function during decompensated heart failure: The cardio-abdomino-renal syndrome. In: Vincent JL, editor. Annual update in intensive care and emergency medicine 2012. Berlin, Heidelberg: Springer Berlin Heidelberg; 2012. p. 577-88.
  26. Testani JM, Khera AV, St John Sutton MG, Keane MG, Wiegers SE, Shannon RP, et al. Effect of right ventricular function and venous congestion on cardiorenal interactions during the treatment of decompensated heart failure. Am J Cardiol 2010; 105(4): 511-6.
  27. Thabt SS, Enany BE, Soliman KR. Fractional sodium excretion and its relation to in-hospital morbidity and mortality in patients admitted with decompensated heart failure. Egypt Heart J 2013; 65(2): 111-5.
  28. Kjaergaard J, Akkan D, Iversen KK, Kober L, Torp-Pedersen C, Hassager C. Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure. Eur J Heart Fail 2007; 9(6-7): 610-6.
  29. Juilliere Y, Barbier G, Feldmann L, Grentzinger A, Danchin N, Cherrier F. Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy. Eur Heart J 1997; 18(2): 276-80.
  30. de Groote P, Millaire A, Foucher-Hossein C, Nugue O, Marchandise X, Ducloux G, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol 1998; 32(4): 948-54.
  31. La Vecchia L, Paccanaro M, Bonanno C, Varotto L, Ometto R, Vincenzi M. Left ventricular versus biventricular dysfunction in idiopathic dilated cardiomyopathy. Am J Cardiol 1999; 83(1): 120-2, A9.
ARYA Atherosclerosis Journal
Volume 17, Issue 1
January and February 2021
Pages 1-5

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