Clinical Research Directory

Spot Analysis of Natriuresis to Guide up- or Down-titration of Diuretic Therapy in Ambulatory Patients With Chronic Heart Failure

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.

Finding Heart Failure in Those Prescribed Loop Diuretics in Primary Care in Jersey

The goal of this clinical trial is to learn whether a simple blood test screening pathway can help diagnose heart failure earlier in adults in primary care who take loop diuretic medicines (such as furosemide or bumetanide) but do not have a recorded diagnosis of heart failure. The main questions it aims to answer are: 1. Does offering a NT-proBNP blood test to eligible patients increase the number of new heart failure diagnoses within 12 months compared with usual care? 2. Does this screening pathway also uncover other important heart problems, such as irregular heart rhythms (arrhythmias) or valve disease? This is a cluster randomised controlled trial, which means that whole GP practices, rather than individual patients, are randomly assigned to one of two approaches: 1. NT-proBNP screening pathway, in which eligible patients are invited for a NT-proBNP blood test 2. Usual care, in which patients continue to be managed as they normally would without proactive screening Participants will: Be identified from GP records if they are prescribed loop diuretics and have no prior diagnosis of heart failure In screening practices, be invited to attend for a free finger-prick NT-proBNP blood test and brief questionnaire Be referred to the heart failure team and invited for an echocardiogram (a heart ultrasound scan) and further assessment if their NT-proBNP level is higher than 125 pg/mL Researchers will compare outcomes between screening and usual-care practices after 12 months, focusing on new diagnoses of heart failure. They will also look at other important cardiovascular findings, such as new arrhythmias, valve disease, and heart failure hospitalisation rates.

Optimization of Fluid Balance Guided by Bioelectrical Impedance Analysis in Patients Undergoing Continuous Renal Replacement Therapy in Critical Care

In critical care, hemodynamic instability often requires volume expansion to restore tissue perfusion, increasing fluid balance and TBW, factors associated with higher mortality. Excess fluid leads to organ dysfunction due to venous congestion, making fluid removal crucial. When diuretics fail, RRT, typically through continuous renal replacement therapy (CRRT), is recommended. However, prescribing the correct level of UF is challenging; insufficient UF can worsen edema, while excessive UF risks hemodynamic instability. This pilot, single-center, prospective, interventional, randomized, controlled, open-label study includes two parallel groups: a standard group with UF prescribed by the physician based on clinical and hemodynamic status and an experimental group with UF guided by the extracellular to total body water (ECW/TBWat) ratio measured by BIA. The aim is to determine if ECW/TBW-guided UF improves fluid and TBW reduction over a 72-hour RRT period.