Ultrasound-Guided Diuretic Therapy in Type 1 Cardiorenal Syndrome: A Randomized, Double-Blind Controlled Trial

Background: Traditional diuretic titration in cardiorenal syndrome (CRS) relies on physical exams.New tools like VExUS show potential, but evidence is limited.This study compares VExUS-guided decongestion to physical exams in improving outcomes. Methods: In this double-blind, randomized, controlled trial, 34 CRS patients undergoing decongestive therapy were enrolled. Clinical Congestion Score (CCS) group with a single observer assessed orthopnea, jugular venous distension, and edema on a scale of 0-3. VExUS group had a different observer evaluating inferior vena cava diameter, hepatic vein, portal vein, and intra-renal venous doppler. Both assessments continued until decongestion (CCS<3;VExUS 0-1) or 7 days. Results: Baseline characteristics were similar, including sick patients (SCr 2.1mg/dL, LVEF 27%, NT-proBNP 19336pg/mL).VExUS-guided treatment showed better trends: higher UNa, lower discharge NT-proBNP, fewer readmissions, and lower in-hospital mortality (see table 1). 30-day mortality was lower in the VExUS-guided group (p=0.05). Conclusion: VExUS-guided treatment was associated to lower 30-day mortality (p=0.05), increased UNa, decreased NT-proBNP at discharge, fewer readmissions, and reduced in-hospital mortality. As the trial continues, a larger population is anticipated to provide more definitive results. Further studies should assess the relevance and impact on these patients.Table 1. Outcomes - Variables Totaln=34 Control group n=12 VExUS groupn=22 p Heart failure readmissionn(%) 7(21.9) 4(33.3) 3(15) 0.37 NT-proBNP at discharge (pg/mL)Median (IQR) 9333(4064-29058) 15658(3492-34813) 7997(4500-26380) 0.19 In-hospital mortalityn(%) 4(12.1) 3(25) 1(4.8) 0.12 Urinary sodium (mmol/L)Median (IQR) 86.2(65-112.6) 85.4(63.5-100.4) 91.5(69-117) 0.36 30-day mortalityn(%) 2(6.2) 2(16.7) 0 0.05