Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients with Heart Failure

Jeffrey M. Testani*, Jennifer S. Hanberg, Susan Cheng, Veena Rao, Chukwuma Onyebeke, Olga Laur, Alexander Kula, Michael Chen, F. Perry Wilson, Andrew Darlington, Lavanya Bellumkonda, Daniel Jacoby, W. H.Wilson Tang, Chirag R. Parikh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

80 Scopus citations


Removal of excess sodium and fluid is a primary therapeutic objective in acute decompensated heart failure and commonly monitored with fluid balance and weight loss. However, these parameters are frequently inaccurate or not collected and require a delay of several hours after diuretic administration before they are available. Accessible tools for rapid and accurate prediction of diuretic response are needed. Methods and Results-Based on well-established renal physiological principles, an equation was derived to predict net sodium output using a spot urine sample obtained 1 or 2 hours after loop diuretic administration. This equation was then prospectively validated in 50 acute decompensated heart failure patients using meticulously obtained timed 6-hour urine collections to quantify loop diuretic-induced cumulative sodium output. Poor natriuretic response was defined as a cumulative sodium output of <50 mmol, a threshold that would result in a positive sodium balance with twice-daily diuretic dosing. Following a median dose of 3 mg (2-4 mg) of intravenous bumetanide, 40% of the population had a poor natriuretic response. The correlation between measured and predicted sodium output was excellent (r=0.91; P<0.0001). Poor natriuretic response could be accurately predicted with the sodium prediction equation (area under the curve =0.95, 95% confidence interval 0.89-1.0; P<0.0001). Clinically recorded net fluid output had a weaker correlation (r=0.66; P<0.001) and lesser ability to predict poor natriuretic response (area under the curve =0.76, 95% confidence interval 0.63-0.89; P=0.002). Conclusions-In patients being treated for acute decompensated heart failure, poor natriuretic response can be predicted soon after diuretic administration with excellent accuracy using a spot urine sample.

Original languageEnglish (US)
JournalCirculation: Heart Failure
Issue number1
StatePublished - Jan 1 2016
Externally publishedYes


  • Diuretic resistance
  • diuretics
  • heart failure
  • poor natriuretic response
  • sodium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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