{"id":"69af20ff0033","type":"article","url":"https://hartvaat.nl/2026/04/27/routinematige-urine-natriummeting-drijft-agressievere-diurese-bij-acuut-hartfale/","title":"Routinematige urine-natriummeting drijft agressievere diurese bij acuut hartfalen","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diuretica"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag119","source_url":"https://doi.org/10.1093/eschf/xvag119","authors":["Amitai Segev","Viana Copeland","David Mark Hochstein","Noam Orvieto","Elad Brav","Fernando Chernomordik","Romana Herscovici","Roy Beigel","Nathaniel M Hawkins","Elad Maor","Shlomi Matetzky"],"significance":6,"published":"2026-05-04","source_date":"2026-04-27","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"In a single-centre implementation study, routine urine sodium measurement was added for 160 cardiac-ICU admissions with acute heart failure from September 2021, compared with 206 historical controls. Post-implementation, patients received higher 72-hour furosemide doses (340 vs 220 mg; p<0.001) and more aggressive diuresis (aOR 4.8). Cumulative urine output was higher (6,250 vs 4,873 mL) and resolution of jugular venous distension and peripheral oedema was faster. Routine urine sodium guides faster, more aggressive decongestion in the cardiac-ICU setting.","created":"2026-07-03T10:32:50Z","updated":"2026-07-03T13:31:46Z","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":"In een single-centerimplementatiestudie werd urine-natrium routinematig gemeten bij alle 160 IC-patiënten met acuut hartfalen vanaf september 2021, en vergeleken met 206 historische controles. Patiënten in de post-implementatieperiode kregen hogere furosemide-doses op 72 uur (340 vs 220 mg; p<0,001) en agressievere diurese (aOR 4,8). Cumulatieve diurese was hoger (6.250 vs 4.873 mL) en oplossing van veneuze stuwing en perifeer oedeem trad sneller op. Routinematige urine-natriummeting in IC-setting helpt om decongestie sneller en agressiever te sturen.","abstract_original":"BACKGROUND AND AIMS: Natriuresis-guided diuresis has been investigated in prospective trials for acute heart failure (HF), but its impact on diuretic prescribing in clinical practice is uncertain. METHODS: From September 2021, routine urine sodium measurement was implemented for all patients admitted with acute HF to our intensive cardiac care unit. We compared diuretic prescribing in 160 prospective post-implementation patients (up to April 2023) with 206 historical controls (from January 2020). Multivariable logistic regression evaluated the odds of aggressive diuretic use, defined as the upper tertile of total furosemide dose administered within the first 72 hours (≥340 mg). Propensity score matching on prespecified covariates created a balanced cohort for sensitivity analysis. RESULTS: The median age was 71 (IQR 60-80), with 252 (69%) men. Post-implementation, patients received higher median total furosemide dose at 72 hours (340 [180-525] mg vs. 220 [120-320] mg; p < 0.001), and were more likely to receive aggressive diuresis (adjusted OR 4.8, 95% CI 2.86-8.25; p<0.001). Propensity score matching of 264 patients yielded consistent results (adjusted OR 5.2, 95% CI 3.004-9.46; p<0.001). At 72 hours, the post-implementation group had higher cumulative urine output (6,250 mL vs. 4,873 mL; p<0.001) and more frequent resolution of jugular venous distension (25% vs. 5%; p<0.001) and peripheral edema (14% vs. 5%; p=0.009), with no difference in pleural effusion (7% vs. 5%; p=0.550). CONCLUSIONS: Routine urine sodium measurement in acute HF patients in intensive care settings was associated with more aggressive diuretic use, increased diuresis, and more rapid improvement in congestion markers."}