2024
Serial direct sodium removal in patients with heart failure and diuretic resistance
Rao V, Ivey‐Miranda J, Cox Z, Moreno‐Villagomez J, Ramos‐Mastache D, Neville D, Balkcom N, Asher J, Bellumkonda L, Bigvava T, Shaburishvili T, Bartunek J, Wilson F, Finkelstein F, Maulion C, Turner J, Testani J. Serial direct sodium removal in patients with heart failure and diuretic resistance. European Journal Of Heart Failure 2024, 26: 1215-1230. PMID: 38556717, DOI: 10.1002/ejhf.3196.Peer-Reviewed Original ResearchConceptsDiuretic resistanceCardiorenal syndromeHeart failureLoop diureticsDiuretic withdrawalHigh-dose loop diureticsN-terminal pro-B-type natriuretic peptidePro-B-type natriuretic peptideGrowth differentiation factor 15Carbohydrate antigen 125Differentiation factor 15Sodium removalRandomized controlled studyCardiorenal parametersDiuretic doseSoluble ST2Natriuretic peptideMedian timeDiuretic responseKidney injuryPeritoneal membraneElectrolyte handlingKidney functionDiureticsInterleukin-6
2021
Compensatory post-diuretic renal sodium reabsorption is not a dominant mechanism of diuretic resistance in acute heart failure
Cox ZL, Rao VS, Ivey-Miranda JB, Moreno-Villagomez J, Mahoney D, Ponikowski P, Biegus J, Turner JM, Maulion C, Bellumkonda L, Asher JL, Parise H, Wilson PF, Ellison DH, Wilcox CS, Testani JM. Compensatory post-diuretic renal sodium reabsorption is not a dominant mechanism of diuretic resistance in acute heart failure. European Heart Journal 2021, 42: 4468-4477. PMID: 34529781, PMCID: PMC8599022, DOI: 10.1093/eurheartj/ehab620.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureSpontaneous natriuresisDiuretic resistanceHeart failureSodium reabsorptionUrine collectionSpot urine sodium concentrationsIntravenous loop diureticsNeutral sodium balanceAcute heart failureDecompensated heart failureRenal sodium reabsorptionSubgroup of patientsUrine sodium concentrationSpot urine samplesDiuretic therapySodium aviditySodium excretionUrine sodiumCreatinine ratioLoop diureticsDiuretic administrationSodium balanceNatriuresisHealthy volunteersNatriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure
Rao VS, Ivey-Miranda JB, Cox ZL, Riello R, Griffin M, Fleming J, Soucier R, Sangkachand P, O'Brien M, LoRusso F, D'Ambrosi J, Churchwell K, Mahoney D, Bellumkonda L, Asher JL, Maulion C, Turner JM, Wilson FP, Collins SP, Testani JM. Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure. Journal Of The American College Of Cardiology 2021, 77: 695-708. PMID: 33573739, PMCID: PMC8114781, DOI: 10.1016/j.jacc.2020.12.022.Peer-Reviewed Original ResearchConceptsLoop diuretic administrationDiuretic therapyNatriuretic responseDiuretic administrationSodium outputAcute decompensated heart failureDecompensated heart failureHeart failure admissionsDaily urine outputSpot urine samplesNet fluid outputNet fluid lossPathway cohortHeart failureLoop diureticsUrine outputDiuretic responseResidual congestionFluid outputTherapyCohortWeight lossAdditional studiesUrine samplesExcellent discrimination
2020
Safety and Efficacy of an Automated Nurse-Driven Diuretic Titration Protocol: the Yale Diuretic Pathway
Meegan G, Sangkachand P, O'Brien M, Riello R, Soucier R, Jacoby D, Gleason O, Fleming J, Griffin M, Ivey-Miranda J, Cox Z, Rao V, Testani J. Safety and Efficacy of an Automated Nurse-Driven Diuretic Titration Protocol: the Yale Diuretic Pathway. Journal Of Cardiac Failure 2020, 26: s22. DOI: 10.1016/j.cardfail.2020.09.070.Peer-Reviewed Original ResearchAcute decompensated heart failureDiuretic doseLoop diureticsSodium outputBlood pressureEMR orderTitration protocolDecompensated heart failureSystolic blood pressureDaily urine outputSpot urine samplesNet fluid outputDiuretic resistanceFurosemide equivalentsFirst doseMedian doseSodium excretionHeart failureSerum potassiumSubsequent dosesUrine outputClinical outcomesMedian timeSerum magnesiumSame doseValidation of Natriuretic Response Prediction Equation in Patients with Acute Decompensated Heart Failure
Gleason O, Meegan G, Fleming J, Griffin M, Ivey-Miranda J, Cox Z, Rao V, Testani J. Validation of Natriuretic Response Prediction Equation in Patients with Acute Decompensated Heart Failure. Journal Of Cardiac Failure 2020, 26: s2. DOI: 10.1016/j.cardfail.2020.09.015.Peer-Reviewed Original ResearchNatriuretic responseSodium outputUrine collectionDiuretic administrationAcute decompensated heart failureIntravenous loop diuretic therapyLoop diuretic administrationLoop diuretic therapySpot urine sodiumDecompensated heart failureHeart failure admissionsRoutine clinical practiceSpot urine samplesNet fluid outputTotal sodium excretionUrine spot samplesADHF patientsDiuretic therapySodium excretionUrine sodiumHeart failureLoop diureticsUrine outputClinical practiceFluid outputRenal Negative Pressure Treatment as a Novel Therapy for Cardio-Renal Syndrome
Maulion C, Asher J, Moskow J, Ivey-Miranda J, Fleming J, Gleason O, Meegan G, Rao V, Testani J. Renal Negative Pressure Treatment as a Novel Therapy for Cardio-Renal Syndrome. Journal Of Cardiac Failure 2020, 26: s6-s7. DOI: 10.1016/j.cardfail.2020.09.027.Peer-Reviewed Original ResearchUrine outputNegative pressure treatmentCreatinine clearanceLoop diureticsTubular pressureAcute decompensated heart failure hospitalizationHF inductionElevated filling pressuresHigh-dose furosemidePrimary therapeutic objectiveCardio-renal syndromeHeart failure hospitalizationHeart failure modelUrinary collecting systemStable cardiac outputDose furosemideCardiac tamponadeFailure hospitalizationSodium excretionHemodynamic profileRenal functionKidney functionR kidneysSwan-GanzCardiac outputMechanisms of Diuretic Resistance Study: design and rationale
Cox ZL, Fleming J, Ivey‐Miranda J, Griffin M, Mahoney D, Jackson K, Hodson DZ, Thomas D, Gomez N, Rao VS, Testani JM. Mechanisms of Diuretic Resistance Study: design and rationale. ESC Heart Failure 2020, 7: 4458-4464. PMID: 32893505, PMCID: PMC7754741, DOI: 10.1002/ehf2.12949.Peer-Reviewed Original ResearchAcute decompensated heart failureDiuretic resistanceDiuretic responseUrine collectionCombination diuretic therapyLoop diuretic administrationLoop diuretic doseLoop diuretic resistanceDecompensated heart failureProspective patient cohortPhysical exam findingsSpot urine collectionADHF hospitalizationsDiuretic doseDiuretic therapyHF outcomesBaseline bloodCommon complicationPatient characteristicsProspective cohortHeart failureLoop diureticsDiuretic administrationUrine biomarkersExam findingsEffect of Loop Diuretics on the Fractional Excretion of Urea in Decompensated Heart Failure
Cox ZL, Sury K, Rao VS, Ivey-Miranda JB, Griffin M, Mahoney D, Gomez N, Fleming JH, Inker LA, Coca SG, Turner J, Wilson FP, Testani JM. Effect of Loop Diuretics on the Fractional Excretion of Urea in Decompensated Heart Failure. Journal Of Cardiac Failure 2020, 26: 402-409. PMID: 32007554, PMCID: PMC7798124, DOI: 10.1016/j.cardfail.2020.01.019.Peer-Reviewed Original ResearchConceptsAcute kidney injuryFractional excretionHeart failureLoop diureticsDecompensated heart failureFurosemide equivalentsKidney injuryProspective cohortDiuretic administrationDiuretic responsePeak diuresisDiuretic effectFEUreaDiureticsPatientsDiagnostic superiorityHospital systemExcretionMagnitude of changeDegree of changeBaselineDistribution of changesFENaDiuresisFailureFirst-in-Human Experience With Peritoneal Direct Sodium Removal Using a Zero-Sodium Solution
Rao VS, Turner JM, Griffin M, Mahoney D, Asher J, Jeon S, Yoo PS, Boutagy N, Feher A, Sinusas A, Wilson FP, Finkelstein F, Testani JM. First-in-Human Experience With Peritoneal Direct Sodium Removal Using a Zero-Sodium Solution. Circulation 2020, 141: 1043-1053. PMID: 31910658, PMCID: PMC7331276, DOI: 10.1161/circulationaha.119.043062.Peer-Reviewed Original ResearchConceptsStandard PD solutionExperimental heart failureHeart failurePD solutionsAdverse eventsPeritoneal dialysisSignificant discomfortSodium removalEnd-stage renal diseaseEnd pointElevated right atrial pressureMaintenance of euvolemiaPrimary end pointSecondary end pointsRight atrial pressureHuman proofLoss of responseSolute removalPorcine experimentsAtrial pressureRenal diseaseLoop diureticsSerum electrolytesHuman studiesPeritoneal membrane
2019
Rapid and Accurate Assessment of Diuretic Response: Validation of an Equation to Predict Diuretic Induced Sodium Output Using a Spot Urine Sample
Griffin M, Struyk G, Fleming J, Shamlian P, Wycallis E, Pattoli M, Thomas A, Stewart B, Barnett J, Gomez N, Ivey-Miranda J, Rao V, Testani J. Rapid and Accurate Assessment of Diuretic Response: Validation of an Equation to Predict Diuretic Induced Sodium Output Using a Spot Urine Sample. Journal Of Cardiac Failure 2019, 25: s52-s53. DOI: 10.1016/j.cardfail.2019.07.148.Peer-Reviewed Original ResearchPoor diuretic responseSpot urine samplesNet fluid balanceDiuretic responseSodium excretionUrine collectionDiuretic administrationSodium outputValidation cohortWeight lossUrine samplesFluid balanceCumulative sodium excretionTypes of diureticsRoutine clinical practiceNet fluid lossAssessment of responseDiuretic doseDiuretic periodDiuretic therapyBladder dysfunctionLoop diureticsSpot urineMedical recordsClinical trialsRenal Diuretic Delivery is Highly Variable in Hospitalized Decompensated Heart Failure Patients and Associated with Diuretic Resistance
Wycallis E, Stewart B, Ivey-Miranda J, Griffin M, Gomez N, Thomas A, Barnett J, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Rao V, Cox Z, Testani J. Renal Diuretic Delivery is Highly Variable in Hospitalized Decompensated Heart Failure Patients and Associated with Diuretic Resistance. Journal Of Cardiac Failure 2019, 25: s3. DOI: 10.1016/j.cardfail.2019.07.018.Peer-Reviewed Original ResearchLoop diureticsADHF patientsTubular sitesRenal perfusionSite of actionRenal urea handlingDecompensated heart failure patientsYale-New Haven HospitalGood urine outputHospitalized ADHF patientsNT-proBNP levelsHeart failure patientsRoute of administrationNew Haven HospitalUrea handlingDiuretic doseDiuretic resistanceFurosemide equivalentsSolute handlingRenal dysfunctionBlood pressureEjection fractionFailure patientsFractional excretionUrine output