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

Status: Recruiting
Location: See location...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Not Applicable
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
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• 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

Locations
Other Locations
Canada
Heart Failure Clinic | St. Joseph's Health Care London
RECRUITING
London
Contact Information
Primary
Christopher W McIntyre, MD
cmcint48@uwo.ca
519.685.8500
Backup
Fabio Salerno, MD
fsalerno@uwo.ca
Time Frame
Start Date: 2020-10-20
Estimated Completion Date: 2026-02-28
Participants
Target number of participants: 50
Treatments
Other: Furosemide Injection
Patients with diuretic resistance:~The presence of diuretic resistance, defined as having clinical signs of fluid overload despite diuretic therapy (this information is routinely collected at each clinical visit). Fluid overload is defined as the presence of at least two of the following clinical features:~* Peripheral or sacral oedema~* Jugular venous distension ≥ 7 cm~* Radiographic pulmonary oedema or pleural effusion~* Enlarged liver or ascites~* Pulmonary rales, paroxysmal nocturnal dyspnoea, or orthopnoea~* Point of Care UltraSound (POCUS) evidence of congestion. Inferior Vena Cava diameter \>2.5 cm and/or failure to collapse at least 50% with sharp inspiration
Related Therapeutic Areas
Sponsors
Leads: London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

This content was sourced from clinicaltrials.gov