Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
Por:
Marcos, MC, Trullàs, JC, Perez-Silvestre, J, Miró, O, Quiroga, B, Mirabet, S, Romero-González, G
Publicada:
1 feb 2026
Resumen:
Background and Aims Urinary sodium (uNa+) is a promising tool to guide diuretic therapy in acute heart failure (AHF), yet its real-world adoption is uncertain. We aimed to evaluate current practices, perceived utility, and barriers to uNa(+)-guided management among physicians managing AHF in Spain. Methods We conducted a nationwide cross-sectional electronic survey in June 2025 of clinicians from cardiology, internal medicine, emergency medicine, and nephrology. The questionnaire assessed the frequency and timing of uNa+ monitoring in inpatient and outpatient settings, thresholds for poor response, therapeutic adjustments, and perceived benefits and barriers. Results A total of 413 physicians responded: 138 (33%) from cardiology, 159 (39%) from internal medicine, 78 (19%) from emergency medicine, and 38 (9%) from nephrology. Overall, 70% reported measuring uNa+ during AHF hospitalization, but only 18% did so routinely. Outpatient application remained infrequent (32%). Nephrologists showed the highest usage in both inpatient (90%) and outpatient (61%) settings. The most frequent cut-off to define diuretic resistance was <50 mmol/l. Therapeutic strategies differed by specialty: loop diuretic escalation was more frequent in cardiology and emergency medicine, while thiazides were preferred in internal medicine and nephrology. Most participants (78%) considered uNa(+) monitoring clinically useful. Major barriers included lack of standardized protocols, limited training, therapeutic inertia, and logistical constraints. Conclusions While uNa(+) monitoring is valued by clinicians, its use in AHF in Spain remains inconsistent across specialties. Addressing implementation barriers through education, protocols, and decision-support tools is critical to a broader adoption of uNa(+) guided therapy in routine care.
Filiaciones:
Marcos, MC:
Hosp Univ Puerta Hierro, Cardiol Dept, C Joaquin Rodrigo 2, Madrid 28222, Spain
Ctr Invest Biomed Red CIBER Cardiovasc, C Monforte Lemos 3-5,Pabellon 11, Madrid 28029, Spain
Trullàs, JC:
Hosp Olot & Comarcal Garrotxa, Internal Med Dept, Girona, Spain
Univ Cent Catalunya, Univ Vic, Fac Med, Lab Reparacio & Regeneracio Tissular TR2Lab, Barcelona, Spain
Perez-Silvestre, J:
Consorcio Hosp Gen Univ Valencia, Internal Med Dept, Valencia, Spain
Miró, O:
Univ Barcelona, Hosp Clin Proc & Pathol, Dept Emergency, Emergencies Res Grp IDIBAPS, Barcelona, Spain
Quiroga, B:
Hosp Univ Princesa, Nephrol Dept, IIS La Princesa, RICORS Renal 2040, Madrid, Spain
Mirabet, S:
Ctr Invest Biomed Red CIBER Cardiovasc, C Monforte Lemos 3-5,Pabellon 11, Madrid 28029, Spain
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Cardiol Dept, Barcelona, Spain
Romero-González, G:
Univ Autonoma Barcelona, Univ Hosp Germans Trias I Pujol, Germans Trias I Pujol Res Inst IGTP, Nephrol Dept Med Dept, Badalona, Spain
Univ Autonoma Barcelona, Germans Trias I Pujol Res Inst IGTP, REMAR IGTP Grp, Can Ruti Campus, Badalona, Spain
Int Renal Res Inst Vicenza, Vicenza, Italy
Green Submitted, gold
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