Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
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....
| Autores: | , , , , , , |
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| Formato: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2026 |
| País: | España |
| Recursos: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p21143 |
| Acesso em linha: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21143 |
| Access Level: | acceso abierto |
| Palavra-chave: | Urinary sodium uNa(+) Natriuresis Acute heart failure |
| Resumo: | 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. |
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