{"id":"0c382e6c37dc","type":"article","url":"https://hartvaat.nl/2026/03/13/tubulaire-nierschade-hangt-samen-met-natriumretentie-en-diureticarespons-bij-acu/","title":"Tubulaire nierschade hangt samen met natriumretentie en diureticarespons bij acuut hartfalen","title_en":"Kidney tubule injury is associated with sodium avidity and diuretic responsiveness in acute heart failure","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","hfpef","hfref","nt-probnp"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag079","source_url":"https://doi.org/10.1093/eschf/xvag079","authors":["Yu Horiuchi","Stephen Duff","Dirk J van Veldhuisen","Michelle M Estrella","Michael G Shlipak","Yoshimitsu Takaoka","Patrick T Murray","Joachim H Ix","Nicholas Wettersten"],"significance":6,"published":"2026-03-13","source_date":"2026-03-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/","https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"Strong sodium retention ('sodium avidity') in acute heart failure (AHF) predicts worse outcomes, but whether kidney tubule injury contributes was unclear. In 339 participants of the ROSE-AHF trial (AHF with kidney dysfunction), urinary injury markers KIM-1, NAG and NGAL were measured at enrolment. Higher KIM-1 and NAG were associated with lower urinary sodium concentration and lower fractional sodium excretion (FeNa); higher KIM-1 was also associated with lower total 72-hour sodium output. None of the markers was associated with urine output. Tubular kidney injury in AHF is thus associated with greater sodium avidity, and KIM-1 with impaired diuretic responsiveness — a possible explanation for diuretic resistance in the cardiorenal syndrome.","created":"2026-07-03T10:32:19Z","updated":"2026-07-03T18:39:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Sterke natriumretentie ('sodium avidity') bij acuut hartfalen (AHF) voorspelt een slechtere uitkomst, maar of tubulaire nierschade hiermee samenhangt was onduidelijk. In 339 deelnemers van de ROSE-AHF-trial (AHF met nierfunctiestoornis) werden bij inclusie de urinaire schademarkers KIM-1, NAG en NGAL gemeten. Een hoger KIM-1 en NAG gingen gepaard met een lagere urinaire natriumconcentratie en een lagere fractionele natriumexcretie (FeNa); een hoger KIM-1 hing bovendien samen met een lagere totale natriumuitscheiding over 72 uur. Geen van de markers was geassocieerd met de urineproductie. Tubulaire nierschade gaat bij AHF dus gepaard met sterkere natriumretentie, en KIM-1 met een verminderde diureticarespons — een mogelijke verklaring voor diureticaresistentie bij het cardiorenale syndroom.","abstract_original":"AIMS: Greater sodium avidity in acute heart failure (AHF) is associated with worse outcomes, but whether kidney tubule injury is associated with sodium avidity and impaired diuretic responsiveness remains underexplored. METHODS: We evaluated 339 participants from the ROSE-AHF trial, which enrolled patients hospitalized for AHF with kidney dysfunction and randomized them to the dopamine, nesiritide or placebo group. Urinary kidney injury molecule-1 (KIM-1), N-acetyl-β-D-glucosaminidase (NAG), and neutrophil gelatinase-associated lipocalin (NGAL) were measured at enrollment. Associations between these biomarkers and urinary sodium (uNa) concentration at baseline, fractional excretion of sodium (FeNa), as well as total uNa output and urine output over 72-hours were assessed using multivariable regression models. RESULTS: Higher KIM-1 and NAG values at baseline were associated with lower uNa concentration at baseline (-6.1% [-8.5%, -3.7%], p < 0.001 and -5.9% [-9.2%, -2.6%], p = 0.001, respectively, per two-fold increase in each biomarker). Higher baseline KIM-1 and NAG were also associated with lower FeNa (-6.1% [-8.5%, -3.6%], p < 0.001 and -5.2% [-8.6%, -3.6%], p = 0.001, respectively, per two-fold increase in each biomarker). Higher baseline KIM-1 was associated with lower total uNa excretion over 72-hours (-3.6% [-6.8%, -0.2%], p = 0.037 per two-fold increase). None of the biomarkers were associated with urine output over 72-hours. CONCLUSION: Kidney tubular injury, as assessed by urine KIM-1 and NAG, is associated with greater sodium avidity and higher KIM-1 is associated with impaired diuretic responsiveness in AHF."}