No possibility to collect reliable urine spot samples after diuretic administration
Administration of any diuretic within 6 h before randomisation, except for a mineralocorticoid receptor antagonist (MRA) or sodium‑glucose co‑transporter 2 (SGLT2) inhibitor as part of the patient’s maintenance treatment for heart failure. Patients can still be included in the DECONGEST study after withholding these diuretics for 6 h, after which randomisation can be performed if they qualify all other criteria.
Severe kidney dysfunction, defined as an estimated glomerular filtration rate (eGFR) <15 mL/min/1.73m² calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD‑EPI) formulaat randomisation, and/or previous, current, or planned future renal replacement therapy
Systolic blood pressure <90 mmHg, mean arterial pressure <65 mmHg, or need for inotropes/vasopressor therapy at randomisation
Any acute coronary syndrome within 30 days prior to enrolment, defined as typical chest pain with a troponin rise above the 99th percentile of normal and/or electrocardiographic changes suggestive of cardiac ischemia
History of heart or kidney transplantation
History of mechanical circulatory support
Known obstructive hypertrophic cardiomyopathy, congenital heart disease, acute mechanical cause of AHF (e.g., papillary muscular rupture), acute myocarditis, or constrictive pericarditis according to the treating physician
Pregnant or breastfeeding woman
Concomitant participation in another interventional study
At least 18 y/o and able to provide informed consent
Hospital admission (anticipated stay >24 h after randomisation) with diagnosis of acute heart failure according to the treating physician
At least one of the following three signs of volume overload:
bilateral oedema 2+, indicating clear pitting
ascites that is amenable for drainage, confirmed by echography
uni- or bilateral pleural effusions that are amenable for drainage, confirmed by chest X-ray or lung ultrasound
Plasma N-terminal of the pro‑hormone of B‑type natriuretic peptide (NTproBNP) level >1,000 ng/L