Thread by @FH_Verbrugge

Really proud moment for me today, presenting 1st time in a Featured Science session @AHAScience.

Deeper insight in #ADVOR trial with key contributions from @WilfriedMullens @PieterMartensMD @JeroenDauw @petra_nijst @EvelyneMeekers among many others. Proudly 🇧🇪!
Tweetorial below!

From #ADVOR population, we included 462 or 89% of patients with 2 correctly performed consecutive urine collections and urine sodium concentration (UNa) available.

Natriuresis:
- UNa [mmol/L] ~ diuretic efficiency
- Total natriuresis [mmol] ~ ECV & interstitial Na buffer removed

#Acetazolamide, after multivariate adjustment, was strongest predictor of #natriuresis in #ADVOR:
UNa + 16 mmol/L
Total natriuresis +115 mmol

👊 within 2 days !!!
👍 much stronger than effect on urine output itself

"#acetazolamide keeps the urine salted"

1. Already on 1st morning after randomization:
more natiuresis 🟰 better decongestion, effect increasing over time

2. Significant interaction between #natriuresis & #acetazolamide

3. Effect #acetazolamide no longer significant after correction for interaction

Conclusion is that the effect of #acetazolamide on decongestion was MEDIATED by an effect on #natriuresis. Good natriuresis translated in shorter length of hospital stay for index admission!

12.5 (UNa <50 mmol/L) to 8 days (UNa >100 mmol/L)

And good clinical outcome without death or #heartfailure readmission...

Very intriguingly, if one has a good natriuretic response to diuretics (UNa >80 mmol/L), it did not matter which diuretics one received.

However, 7 patients treated with #acetazolamide meant 1 more to achieve this target.

Key now is to identify what we need to do with those who have no good natriuretic response to #acetazolamide + #loopdiuretics:
❓Underdosed loop diuretics
❓Need a thiazide as well
❓Volume not the primary problem

For future #Heartfailure trials with #diuretics, remember: "The Key is in the Pee"
#decongestion = #desalinization