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1. The role of urine sodium in acutely decompensated heart failure

Author

Mick Hoen, Delian E Hofman, Bjorn H.A. Hompes, Lukas E.E. Peeters, Bart Langenveld, Roland R.J. van Kimmenade, Leon A.M. Frenken, Timo Lenderink, Hans-Peter Brunner-La Rocca, and Sandra Sanders-Van Wijk

Subjects
Acute heart failure, Urinary sodium, Natriuresis, Diuretic, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Diuretic resistance is common and results in poor outcome. Spot urine sodium (UrNa) is suggested as a tool to tailor diuretics and improve efficacy of therapy. We prospectively evaluate the prevalence of diuretic resistance, predictors of low spot-UrNa and the prognostic value of spot-UrNa in an unselected ADHF population. Methods: Patients admitted for ADHF and treated with iv diuretics were included. Spot-UrNa was collected 2 h after administration of an IV diuretic bolus. The main endpoint was a composite of HF re-hospitalizations and all-cause mortality at 90 days follow-up. Results: 143 patients were included in this study (median age 81 [75 – 85] years, 55 % male), of which 50 % were newly diagnosed with HF. Low spot-UrNa was independently associated with worse renal function, low serum sodium, and systolic blood pressure, previous loop diuretic and SGLT2i use and loop diuretic administered dose. Both absolute spot-UrNa (HR 0.87, 95 % CI 0.79 – 0.95, P=0.003 per 10 mmol/L increase) and a urinary sodium ≥ 100 mmol/l (HR=0.51, 95 % CI 0.27 – 0.97, P=0.04) significantly predicted the composite endpoint. This association was no longer significant after correction for confounders. Patients with low spot-UrNa attained longer IV diuretic treatment and a higher cumulative IV diuretic dose. Conclusions: Spot-UrNa is prevalent and occurs more often in patients with more progressed cardio-renal disease. Spot-UrNa significantly predicts 90-day HF hospital-free survival in ADHF. Further studies are needed evaluating the effect of UrNa guided diuretic treatment on clinical endpoints.

Published
2024
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2. What interventions affect the psychosocial burden experienced by prostate cancer patients undergoing active surveillance? A scoping review

Author

Kim Donachie, Erik Cornel, Thomas Pelgrim, Leslie Michielsen, Bart Langenveld, Marian Adriaansen, Esther Bakker, and Lilian Lechner

Subjects
Male, Prostate cancer, Psychosocial support, Prostatic Neoplasms, Social Support, MEN, UNCERTAINTY, Active surveillance, Lifestyle, Diet, DISTRESS, Oncology, Adaptation, Psychological, MANAGEMENT, Humans, ANXIETY, Watchful Waiting, Exercise
Abstract

Purpose Living with untreated prostate cancer (PCa) may cause anxiety and uncertainty in men undergoing active surveillance (AS). Developing a psychosocial support program for such patients might promote psychosocial well-being and patient engagement. This review aims to identify interventions with the potential to influence the psychosocial burden of prostate cancer patients undergoing AS. Methods A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in six databases and included publications dating from 2009. All available and eligible evidence was included in this review. Results After screening 2824 articles, 12 studies were included in the review: nine quantitative, one qualitative, and two mixed method papers. The relative strength of these studies was limited and the quality of most was moderate. Conclusions The described interventions can be categorized into three major themes: information and education, coping and (psycho)social support, and lifestyle. Psychosocial support for men undergoing AS should entail involvement of family and spouse during the decision-making process, tailored information about PCa treatments, risks, benefits, protocols, lifestyle adjustments, and complementary and alternative medicine. Assessment and promotion of effective coping and self-management strategies are recommended. Healthcare providers should actively promote physical activity and nutritional improvements. Physical activity programs may also be helpful in facilitating peer support, which is especially important for men with limited social support. Future research should investigate combining interventions to increase efficacy and optimize supportive care during AS.

Published
2022

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