The Impact of High-Salt Diet and Diuretics on the Development of the Aestival Phenomenon in Patients with Chronic Heart Failure

Dmitrii O Dragunov^*Anna V SokolovaVadim M MitrokhinArutyunov P Grigory

• Pirogov Russian National Research Medical University, Moscow, Russia

1 отформатировано: Английский (США) удалено: In a study by Nihlén S. et al. [5], it was found that during 39 treatment in the intensive care unit (ICU), diuretic-induced iatrogenic 40 dehydration is associated with a shift towards the intensive 41 production of organic osmolytes, mainly urea. отформатировано: Английский (США) отформатировано: Английский (США) отформатировано: Английский (США) удалено: Recognising that part of the urea rise is an adaptive 84 osmotic response-rather than intrinsic kidney injury-may refine 85 how we interpret worsening renal function during diuresis and reduce 86 unnecessary interruptions of life-saving drugs such as RAAS 87 inhibitors or SGLT2 inhibitors.88 удалено: The study was carried out in the Cardiology Department 89 of GBUZ GVV No3 DZM 90 отформатировано: Английский (США) отформатировано: Английский (США) отформатировано: Английский (США) отформатировано: Английский (США) aminotransferase(ALT), creatine kinase(CK), high-density lipoprotein(HDL), low-density lipoprotein(LDL), triglycerides, cholesterol, creatinine, and C-reactive protein(CRP) were measured.Figure 1: Research design.Participants: Patients with a confirmed diagnosis of chronic heart failure, who had been on stable therapy (ACE inhibitors/ARBs, beta-blockers at more than 50% of the maximum dose) for more than 3 weeks, were included in the study. According to current clinical guidelines and evidence from major randomized trials, a dose of ≥50% is necessary to achieve the proven clinical benefits of betablocker therapy, including reduced mortality and hospitalization. Patients receiving lower doses may represent a less stable population (e.g., undergoing dose titration or with poor tolerance), which could introduce confounding variability in the assessment of metabolic and osmotic adaptations. None of the patients were receiving neprilysin/angiotensin receptor inhibitors (ARNI, such as sacubitril/valsartan) or sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors, such as empagliflozin or dapagliflozin) at the time of inclusion in the study. This was due to the limited availability of these medications in the inpatient setting during the study period and their absence from standard therapy regimens for the majority of patients in the observed cohort. The main inclusion and exclusion criteria are presented in Table 1. The study was conducted in accordance with the Helsinki Declaration and approved by the ethics committee.