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
2023
The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure
Biegus J, Zymliński R, Testani J, Fudim M, Cox Z, Guzik M, Iwanek G, Hurkacz M, Raj D, Marciniak D, Ponikowska B, Ponikowski P. The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure. European Journal Of Heart Failure 2023, 25: 1323-1333. PMID: 37042083, DOI: 10.1002/ejhf.2852.Peer-Reviewed Original ResearchConceptsAcute heart failureDiuretic responseHeart failureChronic usersTubular deliveryUrine volumeAcute heart failure patientsGlomerular filtration rateHeart failure patientsHigher urine volumeDiuretic exposureFurosemide deliveryFurosemide usersGood diuresisFurosemide doseFailure patientsNatriuretic responseFurosemide useTubular responseFiltration rateObservational studyUrine excretionNaïve groupHealthy individualsBody weightThe importance of forward flow and venous congestion in diuretic response in acute heart failure: Insights from the ESCAPE trial
Eder M, Griffin M, Moreno-Villagomez J, Bellumkonda L, Maulion C, Asher J, Wilson F, Cox Z, Ivey-Miranda J, Rao V, Butler J, Borlaug B, McCallum W, Ramos-Mastache D, Testani J. The importance of forward flow and venous congestion in diuretic response in acute heart failure: Insights from the ESCAPE trial. International Journal Of Cardiology 2023, 381: 57-61. PMID: 37023862, DOI: 10.1016/j.ijcard.2023.04.002.Peer-Reviewed Original ResearchConceptsRight atrial pressureDiuretic efficiencyRight atrial areaDiuretic responseVenous congestionHeart failureCardio-renal interactionsLoop diuretic doseAcute heart failureRenal perfusion pressureLow cardiac outputMean arterial pressureRight ventricular systolicCongestive heart failureVentricular ejection fractionNet fluid outputForward flowDiuretic doseDiuretic resistanceTTE parametersCardiac indexVentricular systolicArterial pressureAtrial pressureEjection fractionIn-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility
Ivey-Miranda J, Rao V, Cox Z, Moreno-Villagomez J, Mahoney D, Maulion C, Bellumkonda L, Turner J, Collins S, Wilson F, Krumholz H, Testani J. In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the Utility. Circulation Heart Failure 2023, 16: e010206. PMID: 36896716, PMCID: PMC10186250, DOI: 10.1161/circheartfailure.122.010206.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureDecompensated heart failureDiuretic responseDiuretic dosingOral diureticsHeart failureMulticenter cohortHospital observationLower readmission ratesNet fluid balanceDays postdischargeReadmission ratesHospital readmissionUrine outputReadmission riskFluid statusFluid balanceHospital measuresDose selectionCohortProvider decisionsWeight changeReadmissionDiureticsPatients
2022
Renin-Angiotensin-Aldosterone System Activation and Diuretic Response in Ambulatory Patients With Heart Failure
Amatruda JG, Scherzer R, Rao VS, Ivey-Miranda JB, Shlipak MG, Estrella MM, Testani JM. Renin-Angiotensin-Aldosterone System Activation and Diuretic Response in Ambulatory Patients With Heart Failure. Kidney Medicine 2022, 4: 100465. PMID: 35620081, PMCID: PMC9127684, DOI: 10.1016/j.xkme.2022.100465.Peer-Reviewed Original ResearchDiuretic doseTotal reninDiuretic responseDiuretic resistanceFractional excretionHeart failureActive reninSystem activationRenin-angiotensin-aldosterone system activationHigher plasmaActive renin levelsAldosterone system activationLower diuretic efficiencyPlasma total reninRAAS inhibitor useChronic heart failureMultivariable-adjusted modelsHigh-quality trialsLow fractional excretionFurosemide equivalentsRAAS blockadeAldosterone levelsRAAS activationRenin levelsInhibitor use
2021
The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology
Mullens W, Damman K, Harjola V, Mebazaa A, Rocca H, Martens P, Testani J, Tang W, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic P, Ruschitzka F, Coats A. The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology. Kidneys 2021, 8: 43-61. DOI: 10.22141/2307-1257.8.1.2019.157796.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsUse of diureticsHeart failureElectrolyte disturbancesAcute heart failure episodeAcute heart failureHeart Failure AssociationCommon electrolyte disturbanceHeart failure episodesGoal of therapyResponse/resistanceRelief of congestionSigns of congestionDiuretic resistanceDiuretic strategyDiuretic therapyRenal functionVolume overloadDiuretic responseAvailable guidelinesDiureticsEuropean SocietyFailure episodesPosition statementEuvolaemiaEvaluation of congestionNatriuretic 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
Mechanisms 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 changesFENaDiuresisFailure
2019
The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology
Mullens W, Damman K, Harjola V, Mebazaa A, Rocca H, Martens P, Testani JM, Tang WHW, Orso F, Rossignol P, Metra M, Filippatos G, Seferovic PM, Ruschitzka F, Coats AJ. The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal Of Heart Failure 2019, 21: 137-155. PMID: 30600580, DOI: 10.1002/ejhf.1369.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsUse of diureticsHeart failureElectrolyte disturbancesAcute heart failure episodeAcute heart failureHeart Failure AssociationCommon electrolyte disturbanceHeart failure episodesGoal of therapyResponse/resistanceRelief of congestionSigns of congestionDiuretic resistanceDiuretic strategyDiuretic therapyRenal functionVolume overloadDiuretic responseAvailable guidelinesDiureticsEuropean SocietyFailure episodesPosition statementEuvolaemiaEvaluation of congestion
2017
Renal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure
Maaten J, Rao VS, Hanberg JS, Wilson F, Bellumkonda L, Assefa M, Broughton J, D'Ambrosi J, Tang W, Damman K, Voors AA, Ellison DH, Testani JM. Renal tubular resistance is the primary driver for loop diuretic resistance in acute heart failure. European Journal Of Heart Failure 2017, 19: 1014-1022. PMID: 28105769, PMCID: PMC6231236, DOI: 10.1002/ejhf.757.Peer-Reviewed Original ResearchConceptsAcute heart failureLoop diuretic resistanceRenal tubular responseDiuretic resistanceDiuretic responseRenal tubulesAHF patientsHeart failureLoop diureticsTubular responseRenal tubular resistanceBumetanide doseEffective decongestionIntravenous bumetanidePoor outcomeUrine collectionTubular resistanceSum of defectsPatient variabilityUrea clearancePatientsCommon barriersDoseClearanceDiuretics
2016
Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF)
Grodin JL, Sun JL, Anstrom KJ, Chen HH, Starling RC, Testani JM, Tang WH. Implications of Serum Chloride Homeostasis in Acute Heart Failure (from ROSE-AHF). The American Journal Of Cardiology 2016, 119: 78-83. PMID: 27816115, PMCID: PMC5161696, DOI: 10.1016/j.amjcard.2016.09.014.Peer-Reviewed Original ResearchConceptsAcute heart failureSerum Cl levelsHeart failureClinical outcomesDiuretic responseAcute heart failure trialsRenal Optimization Strategies EvaluationShort-term clinical responseCumulative sodium excretionLoop diuretic doseHeart Failure TrialLong-term mortalitySerum chloride levelsCystatin C changesDiuretic dosePostdischarge outcomesSodium excretionCl levelsClinical responseRenal functionDiuretic efficiencyFailure TrialAdditional adjustmentCystatin CTherapeutic implicationsHypochloremia and Diuretic Resistance in Heart Failure
Hanberg JS, Rao V, Maaten J, Laur O, Brisco MA, Wilson F, Grodin JL, Assefa M, Broughton J, Planavsky NJ, Ahmad T, Bellumkonda L, Tang WH, Parikh CR, Testani JM. Hypochloremia and Diuretic Resistance in Heart Failure. Circulation Heart Failure 2016, 9: e003180. PMID: 27507113, PMCID: PMC4988527, DOI: 10.1161/circheartfailure.116.003180.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersChloridesConnecticutCross-Sectional StudiesDown-RegulationDrug ResistanceFemaleFurosemideHeart FailureHumansKidneyMaleMiddle AgedOdds RatioPilot ProjectsProspective StudiesReninRisk FactorsSodiumSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeConceptsDiuretic resistanceHeart failureCare centerSerum chloridePro-B-type natriuretic peptideChloride supplementationRenal free water excretionB-type natriuretic peptidePoor diuretic responsePlasma renin activityPlasma renin concentrationHeart failure cohortFree water excretionRecent epidemiological studiesBasic science evidenceBlood urea nitrogenSerum chloride levelsFurosemide equivalentsNeurohormonal activationRenin activityRenin concentrationCreatinine ratioLoop diureticsDiuretic responseSerum sodiumHypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure
Ter Maaten JM, Damman K, Hanberg JS, Givertz MM, Metra M, O'Connor CM, Teerlink JR, Ponikowski P, Cotter G, Davison B, Cleland JG, Bloomfield DM, Hillege HL, van Veldhuisen DJ, Voors AA, Testani JM. Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure. Circulation Heart Failure 2016, 9: e003109. PMID: 27507112, DOI: 10.1161/circheartfailure.116.003109.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overBiomarkersChloridesDisease ProgressionDiureticsDown-RegulationDrug ResistanceFemaleHeart FailureHospitalizationHumansKaplan-Meier EstimateLinear ModelsMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRisk FactorsTime FactorsTreatment OutcomeXanthinesConceptsAcute heart failureMEq/L.Heart failureDay 14Serum chloridePoor diuretic responseHours of admissionLower serum chlorideBlood urea nitrogenSerum chloride levelsAHF therapiesDiuretic resistancePROTECT trialNeurohormonal activationMultivariable adjustmentRenal functionHospital admissionMultivariable analysisDiuretic responseDiuretic responsivenessDiuretic targetChloride levelsUrea nitrogenHypochloremiaChloride homeostasisRapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure
Testani JM, Hanberg JS, Cheng S, Rao V, Onyebeke C, Laur O, Kula A, Chen M, Wilson FP, Darlington A, Bellumkonda L, Jacoby D, Tang WH, Parikh CR. Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure. Circulation Heart Failure 2016, 9: e002370. PMID: 26721915, PMCID: PMC4741370, DOI: 10.1161/circheartfailure.115.002370.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAdministration, IntravenousAgedBiomarkersBumetanideDrug MonitoringDrug ResistanceFemaleHeart FailureHumansMaleMiddle AgedModels, BiologicalNatriuresisPredictive Value of TestsProspective StudiesReproducibility of ResultsSodiumSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeUrinalysisConceptsAcute decompensated heart failureDecompensated heart failureNatriuretic responseSpot urine samplesSodium outputHeart failureDiuretic administrationAcute decompensated heart failure patientsDecompensated heart failure patientsLoop diuretic administrationPrimary therapeutic objectiveUrine samplesHeart failure patientsPositive sodium balanceNet fluid outputDiuretic dosingIntravenous bumetanideMedian doseFailure patientsDiuretic responseSodium balanceUrine collectionFluid balanceTherapeutic objectivesFluid output
2015
Diuretic response in acute heart failure—an analysis from ASCEND-HF
Maaten J, Dunning AM, Valente MA, Damman K, Ezekowitz JA, Califf RM, Starling RC, van der Meer P, O'Connor CM, Schulte PJ, Testani JM, Hernandez AF, Tang WH, Voors AA. Diuretic response in acute heart failure—an analysis from ASCEND-HF. American Heart Journal 2015, 170: 313-321.e4. PMID: 26299229, DOI: 10.1016/j.ahj.2015.05.003.Peer-Reviewed Original ResearchConceptsAcute heart failureLow urine outputLower blood pressureDiuretic responseHospital admissionUrine outputBlood pressureHeart failurePoor baseline renal functionGood diuretic responseHeart failure rehospitalizationPoor diuretic responseBaseline renal functionASCEND-HF trialRisk of deathLong-term useDiuretic unresponsivenessNesiritide treatmentCause mortalityRenal impairmentPoor respondersRenal functionClinical predictorsLoop diureticsASCEND-HFSubstantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated Heart Failure Treatment
Testani JM, Brisco MA, Kociol RD, Jacoby D, Bellumkonda L, Parikh CR, Coca SG, Tang WH. Substantial Discrepancy Between Fluid and Weight Loss During Acute Decompensated Heart Failure Treatment. The American Journal Of Medicine 2015, 128: 776-783.e4. PMID: 25595470, PMCID: PMC4475432, DOI: 10.1016/j.amjmed.2014.12.020.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAge FactorsAgedAged, 80 and overBody FluidsCohort StudiesDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Administration ScheduleFemaleFollow-Up StudiesHeart FailureHumansInfusions, IntravenousMaleMiddle AgedRandomized Controlled Trials as TopicRisk AssessmentSeverity of Illness IndexSex FactorsStatistics, NonparametricSurvival RateTreatment OutcomeWeight LossConceptsAcute decompensated heart failureDecompensated heart failureDiuretic Optimization Strategies EvaluationHeart failureWeight lossAcute Decompensated Heart Failure (CARRESS-HF) trialPatient careDecompensated Heart Failure (ASCEND-HF) trialPulmonary Artery Catheterization EffectivenessAcute decompensated heartHeart Failure TrialCongestive heart failureHeart failure researchBaseline characteristicsDiuretic responseFailure TrialLimits of agreementFailure treatmentFluid balanceDecompensated heartNet fluidGreater fluidPatientsCareTreatment