{"id":"e9047026c98f","type":"article","url":"https://hartvaat.nl/2026/11/01/natriuresis-gestuurde-diureticatherapie-verbetert-uitkomst-bij-mannen-met-acuut-/","title":"Natriuresis-gestuurde diureticatherapie verbetert uitkomst bij mannen met acuut hartfalen — PUSH-AHF","title_en":"Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Clinical research in cardiology : official journal of the German Cardiac Society","doi":"10.1007/s00392-026-03030-1","source_url":"https://doi.org/10.1007/s00392-026-03030-1","authors":["Hailun Qin","Lara E E C Zonneveld","Adriaan A Voors","Iris E Beldhuis","Alice Ravera","Dirk J van Veldhuisen","Jenifer E Coster","Wybe Nieuwland","Jan A Krikken","Peter van der Meer","Kevin Damman","Jozine M Ter Maaten"],"significance":5,"published":"2026-10-22","source_date":"2026-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The PUSH-AHF trial conducted a sex-specific analysis of natriuresis-guided diuretic therapy versus standard care in 310 patients with acute heart failure. Guided therapy significantly increased natriuresis and reduced the 180-day risk of heart failure rehospitalization or all-cause mortality in men (adjusted HR 0.51), but showed no benefit in women (adjusted HR 1.40). These exploratory findings highlight potential sex-related differences in diuretic response, underscoring the need for larger confirmatory trials before clinical practice adjustments can be recommended.","created":"2026-10-16T00:50:43Z","updated":"2026-10-16T00:50:43Z","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":"De PUSH-AHF-richtlijn (RCT) onderzocht of natriuresis-gestuurde diureticatherapie bij acuut hartfalen beter werkt dan standaardzorg, met een specifieke focus op geslachtverschillen. Bij mannen leidde de gestuurde aanpak tot meer natriurese en halveerde het het risico op heropname of overlijden binnen 180 dagen (HR 0,51), terwijl vrouwen geen voordeel vertoonden (HR 1,40). Deze exploratieve bevindingen suggereren dat de respons op diuretica mogelijk geslacht-specifiek is, maar bevestiging in grotere studies is noodzakelijk voordat de klinische praktijk kan veranderen.","abstract_original":"AIM: Natriuresis-guided therapy has been proposed as a personalized approach for decongestion in acute heart failure (HF). Given the evidence of sex-related differences in response to decongestive therapy, we performed a sex-specific analysis on the treatment effect of natriuresis-guided therapy in the PUSH-AHF trial. METHODS: The PUSH-AHF trial randomized 310 patients (45% women) to natriuresis-guided therapy or standard of care (SOC). The endpoints of PUSH-AHF were compared between men and women. The 24-h natriuretic response was calculated as 24-h natriuresis divided by the total 24-h loop diuretic dose (mg of bumetanide equivalents). RESULTS: In men, mean total 24-h natriuresis was greater with natriuresis-guided therapy compared to SOC (443 vs. 354 mmol, p = 0.004), whereas in women, this was similar between the groups (357 vs. 336 mmol, p = 0.533, adjusted p-interaction = 0.276). The median 24-h natriuretic response was lower in women receiving natriuresis-guided therapy (23 vs. 52 mmol urinary sodium/mg bumetanide, p = 0.001) when compared to SOC, whereas in men, there was no significant difference between treatment arms (38 vs. 45 mmol respectively, p = 0.337, adjusted p-interaction = 0.009). Natriuresis-guided therapy was associated with a lower risk of 180-day HF rehospitalization or all-cause mortality in men (adjusted HR 0.51 (95% CI, 0.30-0.86; p = 0.011), but not in women (adjusted HR 1.40 (95% CI, 0.67-2.91; p = 0.368), adjusted p-interaction = 0.026). CONCLUSION: Natriuresis-guided therapy was associated with greater natriuresis and a lower risk of 180-day all-cause mortality or HF rehospitalization in men but not in women. These exploratory sex-specific patterns warrant further investigation and confirmation."}