Abstract：
The Pragmatic Urinary Sodium-based algoritHm in Acute Heart Failure (PUSH-AHF) study, published in August of 2023, was the first randomized clinical trial to compare natriuresis-guided decongestion (based on spot urinary sodium measurement) to standard of care in patients with acute heart failure with congestion receiving loop diuretic therapy. Based on results from their trial, the authors concluded that natriuresis-guided loop diuretic treatment was safe and improved natriuresis and diuresis without impacting long-term clinical outcomes. The original PUSH-AHF trial included limited information about renal outcomes and left clinicians with important questions about how natriuresis-guided decongestion might affect their patients\' renal function. On May 12, 2024, however, at the 2024 Annual Congress of the HFA-ESC, Dr. Kevin Damman provided an in-depth exploration of renal outcomes from the trial when he presented a pre-specified, secondary analysis, renal function in the PUSH-AHF trial. This review puts the sub-study findings into context by considering the history of the original trial from which they came from and explaining the need for a close study of its renal outcomes particularly. It highlights the potential impact of renal function in PUSH-AHF on clinical practice and future directions that should be considered by the cardiology research community.
摘要：
急性心力衰竭（PUSH-AHF）的实用尿钠基算法研究，2023年8月发表的这项研究是第一个将利尿剂引导的急性心力衰竭伴充血患者(基于局部尿钠测量)与标准治疗进行比较的随机临床试验.根据他们的试验结果,作者得出的结论是,利尿利尿剂引导下利尿剂治疗是安全的,并且在不影响长期临床结局的情况下改善了利尿利尿和利尿.最初的PUSH-AHF试验包括有关肾脏结局的有限信息，并使临床医生对钠尿引导的充血如何影响患者的肾功能提出了重要问题。2024年5月12日，在2024年HFA-ESC年度大会上，KevinDamman博士对试验的肾脏结果进行了深入探索，二次分析,PUSH-AHF试验中的肾功能。这篇综述通过考虑其来源的原始试验的历史，并特别解释了对其肾脏结局进行密切研究的必要性，从而将子研究结果纳入了背景。它强调了PUSH-AHF中肾功能对临床实践的潜在影响以及心脏病学研究界应该考虑的未来方向。
