Natriuresis-guided diuretic protocols improve fluid removal and shorten hospital stays for acute decompensated heart failure patients compared to standard care approaches in this meta-analysis review

A comprehensive meta-analysis evaluated the impact of natriuresis-guided diuretic protocols versus standard of care in patients with acute decompensated heart failure. The study included 831 participants and assessed multiple outcomes related to fluid management and clinical stability. Results indicated substantial improvements in key diuretic response metrics when using the guided approach.

After twenty-four hours, patients receiving natriuresis-guided therapy demonstrated significantly higher natriuresis levels with a mean difference of 86.71 mmol. By forty-eight hours, this advantage grew to 137.57 mmol, reflecting sustained efficacy in promoting sodium excretion. Diuresis volumes also increased markedly, reaching 0.76 liters at twenty-four hours and 1.11 liters at forty-eight hours under the guided protocol.

Weight loss after forty-eight hours was significantly greater in the intervention group, with a mean difference of -0.45 kg. Furthermore, the length of hospital stay decreased by approximately one day, suggesting faster recovery and discharge. However, no statistically significant differences were found regarding all-cause mortality, heart failure re-hospitalization, or changes in congestion scores between the two groups.

Safety data were not explicitly reported in the included studies, but no serious adverse events or discontinuations were noted in the available information. The findings suggest that tailoring diuretic therapy to natriuresis targets offers tangible benefits for fluid management without increasing risk. These results support the consideration of natriuresis-guided strategies in clinical practice for managing acute decompensated heart failure.