• Anna Rozenfeld, Aliza Goldman, Tal Stern, Shmuel Banai, and Yacov Shacham.
• Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
• Isr Med Assoc J. 2024 Nov 1; 26 (10): 643649643-649.

BackgroundOne-third of patients with acute decompensated heart failure (ADHF) develop worsening kidney function, known as type I cardiorenal syndrome (CRS). CRS is linked to higher mortality rates, prolonged hospital stays, and increased readmissions.ObjectivesTo explore the impact of real-time monitoring of urinary output (UO) trends on personalized pharmacologic management, fluid balance, and clinical outcomes of patients with ADHF admitted to a cardiac intensive care unit.MethodsOur study comprised 35 patients who were hospitalized with ADHF and continuously monitored for UO (UOelec). Standard diuretic and fluid protocols were implemented after 2 hours of oliguria, and patient outcomes were compared to a historical matched control (HMC) group. Patients were assessed for daily and cumulative fluid balance (over 72 hours) as well as for the occurrence of acute kidney injury (AKI).ResultsSignificantly more patients in the UOelec group demonstrated negative fluid balance daily and cumulatively over time in the intensive care unit compared to the HMC group: 91% vs. 20%, respectively (P < 0.0001 for 72-hour cumulative fluid balance). The incidence of AKI was significantly lower in the UOelec monitoring cohort compared to the HMC: 23% vs. 57%, respectively (P = 0.003). Moreover, higher AKI resolution, and lower peak serum creatinine levels were demonstrated in the UOelec group vs. the HMC group.ConclusionsImplementing real-time monitoring of UO in ADHF patients allowed for early response to oliguria and goal-directed adjustment to treatment. This finding ultimately led to reduced congestion and contributed to early resolution of AKI.

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