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....

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Autores: Marcos, MC, Trullàs, JC, Perez-Silvestre, J, Miró, O, Quiroga, B, Mirabet, S, Romero-González, G
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución: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
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21143
Access Level:acceso abierto
Palabra clave:Urinary sodium
uNa(+)
Natriuresis
Acute heart failure
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spelling Urinary sodium to guide diuretic therapy in acute heart failure: results of a national surveyMarcos, MCTrullàs, JCPerez-Silvestre, JMiró, OQuiroga, BMirabet, SRomero-González, GUrinary sodiumuNa(+)NatriuresisAcute heart failureBackground 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.WILEY PERIODICALS, INC2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21143ESC Heart FailureISSN: 20555822reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p211432026-06-14T12:41:47Z
dc.title.none.fl_str_mv Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
title Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
spellingShingle Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
Marcos, MC
Urinary sodium
uNa(+)
Natriuresis
Acute heart failure
title_short Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
title_full Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
title_fullStr Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
title_full_unstemmed Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
title_sort Urinary sodium to guide diuretic therapy in acute heart failure: results of a national survey
dc.creator.none.fl_str_mv Marcos, MC
Trullàs, JC
Perez-Silvestre, J
Miró, O
Quiroga, B
Mirabet, S
Romero-González, G
author Marcos, MC
author_facet Marcos, MC
Trullàs, JC
Perez-Silvestre, J
Miró, O
Quiroga, B
Mirabet, S
Romero-González, G
author_role author
author2 Trullàs, JC
Perez-Silvestre, J
Miró, O
Quiroga, B
Mirabet, S
Romero-González, G
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Urinary sodium
uNa(+)
Natriuresis
Acute heart failure
topic Urinary sodium
uNa(+)
Natriuresis
Acute heart failure
description 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.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21143
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21143
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY PERIODICALS, INC
publisher.none.fl_str_mv WILEY PERIODICALS, INC
dc.source.none.fl_str_mv ESC Heart Failure
ISSN: 20555822
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
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