Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(8), 906–913. https://doi.org/10.1002/clc.24040 Dr. Pau Llàcer et al.
Points
- A study investigated diuretic strategies in acute heart failure with preserved ejection fraction (AHF-pEF) patients, aiming to predict responses using urinary potassium to creatinine ratio (K/Cr).
- Hypothesis: Patients with higher urinary K/Cr ratios would have superior diuretic and natriuretic responses with spironolactone compared to chlorthalidone.
- The study involved 44 AHF-pEF patients with suboptimal responses to loop diuretics, assessing the baseline K/Cr’s association with diuretic and natriuretic effects of chlorthalidone versus spironolactone at 24 and 72 hours.
- Results indicated that chlorthalidone led to a more significant natriuretic and diuretic effect, particularly in patients with higher K/Cr levels. Chlorthalidone outperformed spironolactone in cumulative diuresis at 72 hours.
- The findings did not support the initial hypothesis that the K/Cr ratio could guide the choice of thiazide diuretic versus mineralocorticoid receptor antagonists in AHF-pEF patients receiving loop diuretics.
Summary
This research paper addressed the uncertainty surrounding the most effective diuretic strategy for patients with acute heart failure. It preserved ejection fraction (AHF-pEF) by investigating the predictive potential of the urinary potassium to creatinine ratio (K/Cr). Specifically, the study aimed to determine the diuretic and natriuretic response to either thiazide diuretics or mineralocorticoid receptor antagonists (MRAs) in this patient cohort.
To test their hypothesis, the study involved 44 patients with AHF-pEF who had demonstrated suboptimal responses to loop diuretics. The primary endpoint of the research was to evaluate the baseline K/Cr’s association with the natriuretic and diuretic effects of chlorthalidone versus spironolactone at 24 and 72 hours. The analysis employed mixed linear regression models, and estimates were presented as least squares means with their respective 95% confidence intervals (CIs).
The study findings indicated that chlorthalidone exhibited a more pronounced natriuretic and diuretic effect across different K/Cr levels. Notably, in the subgroup with higher K/Cr levels, chlorthalidone resulted in a statistically significant increase in natriuresis at 24 and 72 hours. Chlorthalidone also outperformed spironolactone in cumulative diuresis at 72 hours, irrespective of the patient’s K/Cr status. The omnibus p-value for these results was found to be 0.027.
In conclusion, this study revealed that for patients with AHF-pEF who demonstrated suboptimal diuretic responses, chlorthalidone was associated with higher diuresis and natriuresis than spironolactone. These findings did not support the initial hypothesis that the K/Cr ratio could be used as a guiding factor in choosing between thiazide diuretics and MRAs for AHF-pEF patients already on loop diuretics.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24040
References Llàcer, P., Núñez, J., Croset, F., García, M., Fabregate, M., Ruiz, R., López, G., Fernández, C., Del Hoyo, B., Campos, J., Gomis, A., & Manzano, L. (2023). Usefulness of urinary potassium to creatinine ratio to predict diuretic response in patients with acute heart failure and preserved ejection fraction. Clinical Cardiology, 46(8), 906–913. https://doi.org/10.1002/clc.24040
