SURE-HF: Urinary Sodium-Guided Diuretic Therapy in Heart Failure

Summary

The SURE-HF trial is a pragmatic, multicentre, randomized controlled study evaluating natriuresis-guided optimization of intravenous loop diuretic therapy in patients hospitalized with worsening heart failure (WHF). The study aims to determine whether serial urinary sodium assessment combined with a structured decongestive treatment algorithm improves decongestion, reduces the need for therapy escalation, and enhances discharge readiness compared with standard care.

Participants will be randomized to standard urine output-guided therapy or natriuresis-guided decongestive strategies using different intravenous loop diuretic administration regimens. The study integrates bedside diagnostic tools including lung ultrasound, inferior vena cava assessment, focused echocardiography, and serial clinical congestion monitoring.

The primary endpoint is a hierarchical composite outcome including escalation of heart failure therapy, persistent congestion at discharge, inability to transition to oral loop diuretics by Day 5, and residual ultrasound congestion. The findings of the SURE-HF trial may support implementation of urinary sodium-guided and ultrasound-assisted decongestive therapy in routine heart failure management.

Conditions

• Worsening Heart Failure
• Congestion
• Heart Failure

Interventions

DRUG

Furosemide

Intravenous loop diuretic therapy administered according to predefined treatment algorithms, including intermittent bolus administration, continuous infusion, or prolonged intermittent infusion with protocol-driven dose titration.

DEVICE

Horiba LAQUAtwin B-722

Portable point-of-care urinary sodium analyzer used for serial spot urinary sodium measurements to guide decongestive therapy.

Sponsors & Collaborators

• I.M. Sechenov First Moscow State Medical University

  collaborator OTHER

• Nurgul Ablakimova

  lead OTHER

Principal Investigators

• Nurgul Ablakimova, PhD · West Kazakhstan Marat Ospanov Medical University

• Vadim Medovchshikov, PhD · West Kazakhstan Marat Ospanov Medical University

• Anzhela Soloveva, candidate of medical sciences · I.M. Sechenov First Moscow State Medical University

• Svetlana Rachina, doctor of medical sciences · I.M. Sechenov First Moscow State Medical University

• Gaziza Smagulova, candidate of medical sciences · West Kazakhstan Marat Ospanov Medical University

• Ayagoz Meshitbayeva · West Kazakhstan Marat Ospanov Medical University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-06-30

Primary Completion

2027-12-31

Completion

2027-12-31

Countries

• Kazakhstan

Study Locations