RecruitingNot ApplicableNCT04170855

Kidney Sodium Content in Cardiorenal Patients

Evaluation of Kidney Medullary Sodium Content Using 23Na MRI to Understand and Predict Diuretic Resistance

Sponsor

London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

Enrollment

50 participants

Start Date

Oct 20, 2020

Study Type

INTERVENTIONAL

Conditions

Cardio-Renal Syndrome

Summary

Diuretic therapy is the cornerstone of the management of fluid overload in heart failure. Resistance to diuretic therapy is the most common reason for treatment failure in patients affected by the combination of heart failure and kidney disease. Currently, there is no way of predicting whether heart failure patients will develop resistance to diuretic therapy and what dose of diuretic is necessary to overcome diuretic resistance. Answering these questions would allow doctors to be able to prescribe an accurate dose of diuretic therapy to prevent diuretic resistance and potential side effects of an excessive diuretic dose. With magnetic resonance imaging, it is possible to measure the kidney sodium (salt) content and observe the diuretic response in patients with heart failure and kidney disease. The investigators speculate that measuring kidney sodium content will allow to predict diuretic response in these patients. The aim of this study is to compare the kidney sodium content in patients with chronic cardiorenal syndrome with and without diuretic resistance. Secondly, in a sample of patients with diagnosed diuretic resistance,the aim will be to observe the changes in kidney sodium content induced by an additional dose of diuretic therapy and to observe whether these changes are associated with a response to diuretic therapy.

Eligibility

Min Age: 18 Years

Inclusion Criteria5

Clinico-pathological diagnosis of heart failure
Age ≥ 18 years
Estimated GFR ≥ 15 mL/min/1.73m2
Receiving loop diuretics for at least a week at ≥ 40 mg/day (furosemide) or 2 mg/day (bumetanide), either orally or intravenously
Willing and able to provide consent

Exclusion Criteria6

Additional diuretic types other than spironolactone/epleronone/metolazone/finerenone
Liver disease with hepato-renal syndrome
Pregnant, breastfeeding or intending pregnancy
Kidney malformation leading to chronic kidney disease (for example polycystic kidney)
Unable to provide consent
· Hypokalemia (serum potassium \<3.5 mmol/l)

Interventions

DRUGFurosemide Injection

We will measure kidney sodium content in patient with cardiorenal syndrome. we will inject within the week of this first measurement furosemide only in patient who will be resistant to diuretics (Based on these parameters, diuretic response will be defined as: * A reduction in fractional spot urinary sodium * An increase in urinary volume * A \>1 kg reduction in body weight within 24 hours from diuretic administration (extrapolation of guidance on management of acute HF) and we will do another measurement of kidney sodium content after furosemide injection.