Perioperative medicine & outcomes
Protocolized natriuresis-guided diuretic therapy in acute heart failure: a systematic review and meta-analysis
Authors' conclusion
In this meta-analysis of patients with AHF, protocolized natriuresis-guided therapy was safe and associated with improved diuresis and natriuresis after 48 h, as well as a reduced risk of acute kidney injury.
Study context
- Population
- Patients with acute heart failure
- Participants
- 933 patients · 3 randomized controlled trials (RCTs) · 2 observational studies
- Comparison
- Natriuresis-guided diuretic therapy vs standard management
- Protocolized therapyn = 404
- Outcome
- Natriuresis and diuresis
- Follow-up
- 48 h
Methodological detailssensitivity analysis restricted to RCTs, Risk of bias: 2 RCTs low, Bayat et al. some concerns (RoB 2); ENACT-HF moderate, Pellegrino et al. serious (ROBINS-I)
- Sensitivity analysis restricted to RCTs
- Risk of bias: 2 RCTs low, Bayat et al. some concerns (RoB 2); ENACT-HF moderate, Pellegrino et al. serious (ROBINS-I)
Pooled result
As reported in the abstract
Protocolized therapy vs Standard managementGeometric mean ratio (95% CI)
Natriuresis
1.30(1.14–1.49)
Diuresis
1.21(1.09–1.35)
Further pooled results
Weight loss, hospital LOS, HF rehospitalization, all-cause mortality
- No significant differences
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Doubling of serum creatinine | 0.52 (0.28–0.98) | |
| 0.20.5125Relative risk (log scale) |
Doubling of serum creatinine
- No increased risk of hypokalemia or hypotension
Original publication
Protocolized natriuresis-guided diuretic therapy in acute heart failure: a systematic review and meta-analysis. Crit Care. Published 5 November 2025. doi:10.
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