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
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 doseEffect 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
Safety and Efficacy of an Auto-Titrating Diuretic Protocol: A Pilot
Griffin M, Flemming J, Pattoli M, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Struyk G, Shamlian P, Mahoney D, Ivey-Miranda J, Ivey-Miranda J, Rao V, Testani J. Safety and Efficacy of an Auto-Titrating Diuretic Protocol: A Pilot. Journal Of Cardiac Failure 2019, 25: s52. DOI: 10.1016/j.cardfail.2019.07.147.Peer-Reviewed Original ResearchDiuretic resistanceFurosemide equivalentsRenal functionBlood pressureHeart failureWeight lossHeart failure physiciansNon-randomized pilotTraditional diuretic therapyMajority of patientsSystolic blood pressureRapid dose escalationMaximum daily doseSpot urine samplesDiuretic doseDiuretic protocolDiuretic therapyDiuretic dosesHF patientsSodium excretionStarting doseElectrolyte abnormalitiesHospital daysDaily doseDose escalationRenal 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
2018
Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center's Experience
Goljo E, Soufer A, Colna M, Rao V, D'Ambrosi J, Riello R, Mahoney D, Tang W, Testani J. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center's Experience. Journal Of Cardiac Failure 2018, 24: s32. DOI: 10.1016/j.cardfail.2018.07.093.Peer-Reviewed Original ResearchAcute decompensated heart failureHypertonic saline solutionDecompensated heart failureHSS administrationHeart failureSerum sodiumHypertonic salineTreatment responseSetting of ADHFHigh-dose loop diureticsMethods Electronic medical recordsLarge urban academic hospitalInotropes/vasopressorsReal-world safetySerum sodium concentrationUrban academic hospitalPotential therapeutic effectsNet fluid outputPositive treatment responseAdditional rigorous studiesElectronic medical recordsImprovement of creatinineADHF patientsFurosemide equivalentsCenter experience