Natriuresis-Guided Diuretic Therapy for Heart Failure
(SAND-HF Trial)
What You Need to Know Before You Apply
What is the purpose of this trial?
Heart failure is a chronic condition that causes congestion and frequent hospitalizations. Diuretic doses are usually adjusted based on clinical judgment without an objective measure of response. This study will test the feasibility of using point-of-care urine sodium measurements to guide up-titration or down-titration of loop diuretics in ambulatory patients with heart failure.
Participants will be assigned to one of three groups based on congestion status. Groups 1 and 2 will be randomized 1:1 to natriuresis-guided therapy or standard care. Group 3 will be observational. The 90-day pilot trial will evaluate feasibility, clinical outcomes, and usability of a urine sodium-guided titration strategy.
Are You a Good Fit for This Trial?
This trial is for adults over 18 with heart failure who live in specific regions. Group 1 includes those with significant congestion or on stable furosemide for at least a week. Group 2 consists of patients with mild symptoms, no recent hospitalization, and stable on furosemide for a month. Group 3 will include the first 100 eligible patients not fitting into Groups 1 or 2.Inclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Baseline Assessment
Baseline urine sodium assessment and initial clinical evaluations
Treatment
Participants receive natriuresis-guided or standard care diuretic titration
Follow-up
Participants are monitored for safety and effectiveness after treatment
What Are the Treatments Tested in This Trial?
Interventions
- Natriuresis-Guided Down-Titration
- Natriuresis-Guided Up-Titration
Trial Overview
The study tests if measuring urine sodium to adjust water pill doses (up-titration/down-titration) is feasible and effective compared to standard care in managing heart failure. Participants are divided into three groups: two undergoing natriuresis-guided therapy versus standard care, and one observational group.
How Is the Trial Designed?
5
Treatment groups
Experimental Treatment
Participants who do not meet inclusion criteria for Groups 1 or 2 will undergo baseline urine sodium assessment and routine clinical follow-up. No study-directed titration will occur.
Participants will receive usual care without urine sodium-guided adjustments.
Loop diuretic doses will be reduced based on urine sodium levels. If urine sodium ≥80 mmol/L, the current dose will be maintained; if \<80 mmol/L, dose will be reduced according to a predefined algorithm. Re-titration criteria include symptomatic weight gain \>2 kg in one week.
Participants will receive usual clinical management of diuretics at the discretion of their treating physician without access to urine sodium-guided titration.
Loop diuretic doses will be up-titrated based on post-diuretic urine sodium concentration measured using a point-of-care sensor. Insufficient natriuresis (\<80 mmol/L) will prompt dose escalation according to a predefined algorithm.
Find a Clinic Near You
Who Is Running the Clinical Trial?
Cardiology Research UBC
Lead Sponsor
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