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19.06.2025 19:25
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✍️ Writing this review was a true pleasure.
We hope it brings you as much insight as it brought us joy.
May it inspire fresh thinking, open debate, and new paths in HF decongestion.
Disagree freely - dialogue is how we move forward.
💡🫀 #heartfailure
🔬 Dive into the full review by Frederik Verbrugge and myself in Eur J Heart Fail (2025):
📄 “Water and electrolyte homeostasis during decongestion in heart failure”
🧠 A must-read for anyone treating HF. onlinelibrary.wiley.com/doi/10.1002/...
#medsky #cardiosky #cardiology #meded
🧠 Take-home pearls:
📌 HF: Na⁺ > water retention, K⁺ depletion
📌 Diuretics: further depletion of water, K⁺ and Cl⁻
📌 Balanced diuresis compensates for these losses and restores homeostasis
Aim for 🧪 physiology-guided decongestion - not just diuresis!
🛠️ How do we get there?
🧃 Liberal water intake
🧂 KCl over K-citrate/gluconate for dual K⁺ + Cl⁻ support
💊 Early acetazolamide and SGLT2i to reduce Cl⁻ loss
🧪 Use urine Na⁺ to guide decongestion & aim for 150-250mmmol net Na⁺ removal per 1kg above "dry weight"
💊 So, what should we aim for?
“Balanced Diuresis” means:
✅ Remove Na⁺ effectively (natriuresis!)
✅ Preserve Cl⁻ & K⁺
✅ Prevent intracellular dehydration
💧 Net fluid loss is not enough - composition matters.
🧬 Cl⁻: the forgotten ion.
Cl⁻:
🔹 Senses volume status at the macula densa
🔹 Regulates acid–base via the strong ion difference (SID)
🔹 Modulates neurohormonal feedback
💥 HypoCl⁻ = diuretic resistance + reduction in effective circulating volume
🧪 Why does K⁺ matter?
🧠 K⁺ maintains key cellular functions and is the predominant intracellular osmolyte.
In HF:
📉 TEK⁺ (total exchangeable K⁺) is reduced
⬇️ Buffer capacity for K⁺ fluctuations
🔁 Risk of hypoK⁺ → ↑mortality, ↑arrhythmia, ↑diuretic resistance
⚠️ Diuretics are indispensable tools, but they are physiologically clumsy.
They cause:
🥵 Electrolyte-free water loss (mostly from intracellular compartments)
🧂 Disproportionate Cl⁻ excretion
⚡ Further K⁺ depletion
🚱 And with fluids? Intracellular dehydration worsens.
🔄 The Na⁺ story gets even more interesting:
HF causes:
🔹 Intracellular Na⁺ shifts
🔹 Extracellular Na⁺ buffering by glycosaminoglycans (GAGs)
🔹 Displacement of K⁺, Mg²⁺, H⁺
💣 Net result: electrolyte imbalance + loss of cellular osmolytes.
💡 In HF, Na⁺ is retained out of proportion to water.
📊 TENa⁺ (total exchangeable Na⁺) increases > TBW (total body water).
In fact, Na⁺ retention is the primary culprit in HF; water retention is a secondary phenomenon!
Most Na⁺ accumulates in the extracellular space.
🚨 Heart failure (HF) decongestion ≠ simple fluid removal.
Let’s explore the fascinating electrolyte changes happening behind the scenes and how they interact with diuretic therapy. 🫀💧⚡
Here follows a thread.🧵
Full review by Frederik Verbrugge and me: onlinelibrary.wiley.com/doi/10.1002/...
A huge congratulations to our lead author Hannah Van Belle, supervisor Alexander Van De Bruaene, and all the amazing co-authors who made this work possible. Your dedication and teamwork were instrumental!
This step is crucial for understanding and addressing the full impact of kidney disease in this population.
In this study, we found that albuminuria affects up to one-third of Fontan patients, emphasizing the need to incorporate the urine albumin-to-creatinine ratio (UACR) into chronic kidney disease classifications.
Thrilled to share our latest publication on #albuminuria in #Fontan patients: pubmed.ncbi.nlm.nih.gov/39688686/.
This paper holds a special significance for me—it marks my 200th peer-reviewed publication and was published on my 26th birthday. Truly, the best gift I could have asked for! 🎉
Conduction Disturbances After #TAVR #TAVI: An Update on Epidemiology, Preventive Strategies & Management
#SOTA
#JACCINT #CardioSky #Epeeps
@jaccjournals.bsky.social @accintouch.bsky.social
www.jacc.org/doi/10.1016/...
Long-Term Management of Right Ventricular Outflow Tract Dysfunction in Repaired Tetralogy of Fallot #TOF #ACHD
#CardioSky #MedSky
@ahascience.bsky.social
@ahajournals.bsky.social
professional.heart.org/en/science-n...
Starter pack directory for anyone trying to figure out who to follow! Search whatever keywords you like. There are also instructions for having your starter pack added to the list. #MedSky #Medicine #STEM
Would love to be added! Great initiative!
Stay connected & share your insights with the JACC Journals community by using our hashtags & tagging @jaccjournals.bsky.social:
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Imagine seeing a neonate with #Taussig-#Bing #anomaly (#transposition physiology ❤) with concomitant #anomalous #connection of the circumflex #coronary artery to the #pulmonary #trunk (ACAPT)... What are implications for management during the #ASO?
academic.oup.com/ehjcr/advance-…
authors.elsevier.com/a/1fxxc55Cs4aIM
Arteriovenous Fistulae in Chronic Kidney Disease and the Heart: Physiological, Histological, and Transcriptomic Characterization of a Novel Rat Model
ahajournals.org/doi/10.1161/JA…
How does staged #Fontan palliation impact on #somatic #growth in #singleventricle patients? We performed this systematic review and meta-analysis to find this out for you!
onlinelibrary.wiley.com/doi/abs/10.111…
Check out our latest article "Long-Term Consequences of Acute Kidney Injury after Pediatric Cardiac Surgery: A Systematic Review", published in The Journal of Pediatrics!
sciencedirect.com/science/articl…
