{"id":"439079c1382f","type":"article","url":"https://hartvaat.nl/2026/07/31/hoge-serumbicarbonaat-bij-opname-voorspelt-diuretische-resistentie-bij-acute-har/","title":"Hoge serumbicarbonaat bij opname voorspelt diuretische resistentie bij acute hartfalenexacerbatie","title_en":"Admission serum bicarbonate is associated with early diuretic resistance in acute decompensated heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Cardiovascular journal of Africa","doi":"10.5830/CVJA-2026-021","source_url":"https://doi.org/10.5830/CVJA-2026-021","authors":["Kayıhan Karaman","Sefa Erdi Ömür"],"significance":4,"published":"2026-08-14","source_date":"2026-07-31","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"A retrospective single-centre cohort of 1,000 patients with acute decompensated heart failure found that elevated admission serum bicarbonate (>28 mmol/L) is independently associated with early diuretic resistance and less effective decongestion. Patients with this alkalosis phenotype required earlier diuretic escalation, had smaller 24- to 48-hour fluid losses, and exhibited lower early urine sodium levels. Incorporating bicarbonate into urine-sodium-guided decongestion protocols may enable faster, more objective diuretic titration, though prospective trials are needed to confirm impact on clinical outcomes.","created":"2026-08-07T01:32:00Z","updated":"2026-08-10T10:35:39Z","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":"Een retrospectieve cohortstudie van 1000 patiënten met acute decompensatie van hartfalen toont aan dat een verhoogde serumbicarbonaatwaarde bij opname (> 28 mmol/l) onafhankelijk samenhangt met vroege diuretische resistentie en minder effectieve ontwatering. Patiënten met dit metabool alkalose-phenotype hadden een hogere kans op diureticumescalatie binnen 48 uur, minder vochtverlies en een lagere vroege urine-natriumconcentratie. Het opnemen van bicarbonaat als eenvoudige laboratoriumparameter in ontwateringsprotocollen kan helpen om diureticumtherapie sneller en objectiever aan te passen, al zijn prospectieve trials nodig om de klinische meerwaarde te bevestigen.","abstract_original":"BACKGROUND: Acute decompensated heart failure (ADHF) exhibits a heterogeneous diuretic response. Chloride-bicarbonate imbalances may reduce loop diuretic efficiency. The effect of admission bicarbonate levels on diuretic resistance in unselected ADHF patients remains unclear. We aimed to evaluate whether higher admission bicarbonate identifies patients at risk of early diuretic dose escalation and less effective early decongestion. METHODS: Our study was planned as a retrospective, single-centre, consecutive ADHF cohort. This study included 1000 hospitalised patients with ADHF (mean age 69 years, ± 11.2 years, 42.7% female) who underwent arterial blood sampling and pH ranging from 7.35 to 7.45. Patients were divided into three groups according to their admission bicarbonate value (< 22 mmol/L-group 1, 22-28 mmol/L-group 2, > 28 mmol/L-group 3). The primary endpoint was early diuretic escalation within 48 hours (dose doubling and/or thiazide add-on or infusion switch). Secondary endpoints included diuretic efficiency, 24/48-hour net fluid balance, 48-hour weight change, early spot urine sodium, and safety/utilisation metrics. Multivariable models adjusted for prespecified clinical and laboratory covariates and baseline diuretic regimen. RESULTS: Higher admission bicarbonate (particularly > 28 mmol/L) was independently associated with greater odds of early escalation and with less effective decongestion. Patients with higher bicarbonate demonstrated lower diuretic efficiency, smaller 24-48 hour net fluid losses, attenuated early weight reduction, and lower early urine sodium. Companion markers (lower chloride, higher pH and pCO2) paralleled these findings, consistent with an alkalosis phenotype. CONCLUSION: Admission bicarbonate is a simple, physiologically coherent marker of early decongestion dynamics in ADHF. Embedding this chemistry-based flag within urine-sodium-guided protocols may enable earlier, objective intensification of pharmacologic therapy and more efficient decongestion. Prospective trials should test bicarbonate-informed pathways against usual care on clinical outcomes."}