{"id":5652,"date":"2026-07-31T11:32:37","date_gmt":"2026-07-31T09:32:37","guid":{"rendered":"https:\/\/cvja.co.za\/journal\/?p=5652"},"modified":"2026-07-31T11:32:37","modified_gmt":"2026-07-31T09:32:37","slug":"cvja-2026-021","status":"publish","type":"post","link":"https:\/\/cvja.co.za\/journal\/cvja-2026-021\/","title":{"rendered":"Admission serum bicarbonate is associated with early diuretic resistance in acute decompensated heart failure"},"content":{"rendered":"    <div id=\"article\">                                                                                                                        \r\n        <div id=\"title-container\">                                                                                                    \r\n        <div id=\"authors-title\">                                                                                                            \r\n        <!--Aurthors under Title-->                                                                                                            \r\n            \r\nKay\u0131han Karaman, Sefa Erdi \u00d6m\u00fcr\r\n<\/div>        \r\n<\/div>                                                                                                                            \r\n            <div id=\"copyright\">\r\n        <strong>Copyright:<\/strong> Clinics Cardive Publishing (Pty) Ltd. publisher\r\n        of Cardiovascular Journal of Africa.<\/div>\r\n    <div style=\"clear: both;\"><\/div>                                                                                                                                \r\n        <div id=\"article-abstract\">                                                                                                            \r\n            <div id=\"abstract-title\">                                                                                                        \r\n                    Abstract                                                                                                                \r\n                <\/div>                                                                                                                        \r\n                                                                                                                                \r\n            <div id=\"abstract-content\">                                                                                                        \r\n            <!--Content of Abstract Article-->                                                                                                \r\n            <!--<strong>\"Abstract titles\":<\/strong>-->                                                                                        \r\n            <!--<br\/> at the end of each section!!-->                                                                                        \r\n                                                                                                                                                    \r\n\r\n        <strong>Background:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nAcute decompensated heart failure (ADHF) exhibits a heterogeneous diuretic response. Chloride-bicarbonate imbalance may reduce loop diuretic efficiency. The effect of admission bicarbonate levels on diuretic resistance in unselected ADHF patients remains unclear. We aimed to evaluate whether higher admission bicarbonate identifies patients at risk of early diuretic dose escalation and less effective early decongestion.\r\n<br \/>    \r\n\r\n        <strong>Methods:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nOur study was planned as a retrospective, single-centre, consecutive ADHF cohort. This study included 1000 hospitalised patients with ADHF (mean age 69 years, \u00b1 11.2 years, 42.7% female) who underwent arterial blood sampling and had pH ranging from 7.35 to 7.45. Patients were divided into three groups according to their admission bicarbonate value (< 22 mmol\/L \u2013 group 1, 22\u201328 mmol\/L \u2013 group 2, > 28 mmol\/L \u2013 group 3). The primary endpoint was early diuretic escalation within 48 hours (dose doubling and\/or thiazide add-on or infusion switch). Secondary endpoints included diuretic efficiency, 24\/48-hour net fluid balance, 48-hour weight change, early spot urine sodium, and safety\/utilisation metrics. Multivariable models adjusted for prespecified clinical and laboratory covariates and baseline diuretic regimen.\r\n<br \/>\r\n                \r\n                <strong>Results:<\/strong>                                                                                                    \r\nHigher admission bicarbonate (particularly > 28 mmol\/L) was independently associated with greater odds of early escalation and with less effective decongestion. Patients with higher bicarbonate demonstrated lower diuretic efficiency, smaller 24- and 48-hour net fluid losses, attenuated early weight reduction, and lower early urine sodium. Companion markers (lower chloride, higher pH and pCO\u2082) paralleled these findings, consistent with an alkalosis phenotype.\r\n<br \/>\r\n                                                                                                                                                                                                                                                                        \r\n                                                                                                                                                \r\n        <strong>Conclusion:<\/strong>                                                                                                    \r\n                                                                                                                                                    \r\nAdmission bicarbonate is a simple, physiologically coherent marker of early decongestion dynamics in ADHF. Embedding this chemistry-based flag within urine-sodium-guided protocols may enable earlier, objective intensification of pharmacologic therapy and more efficient decongestion. Prospective trials should test bicarbonate-informed pathways against usual care on clinical outcomes.\r\n<br \/>    \r\n                                                                                                        \r\n\r\n                                                                                                                                                \r\n            <\/div>                                                                                                                            \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                        \r\n                                                                                                                                                \r\n        <div id=\"keywords\">                                                                                                                    \r\n                                                                                                                                            \r\n            <strong>Keywords:<\/strong>                                                                                                        \r\n                                                                                                                                            \r\n            <strong>acute decompensated heart failure, bicarbonate, diuretic resistance, diuretic dose escalation<\/strong>                                                                                                                                                                                                                    \r\n                                                                                                                                                \r\n        <\/div>                                                                                                                                    \r\n                                                                                                                                                \r\n    <div id=\"publish-info\">                                                                                                                    \r\n                                                                                                                                \r\n    <strong>Submitted:<\/strong> October 28, 2025; <!--Month day, year; -->    \r\n    <strong>Accepted:<\/strong> March 26, 2026; <!--Month day, year; -->                                                                            \r\n    <strong>Published:<\/strong> July 31, 2026<!--Month day, year; -->                                                                                                                            <br \/>                                                            \r\n        <em>Cardiovasc J Afr 2025; <b>37<\/b>: 275-281<!--pg no. till pg no. \"eg. 4-7\"--><\/em>\r\n        <br \/><strong>Volume 37, Issue 3<\/strong> <br \/>                                                                            \r\n        <\/div>                                                                                                                            \r\n                                                                                                                                        \r\n    <div id=\"DOI\">                                                                                                                    \r\n            DOI Citation Reference: dx.doi.org\/10.5830\/CVJA-2026-021<!--DOI number-->                                                                \r\n        <\/div>                                                                                                                            \r\n                \r\n                <div id=\"author-affiliation\">                                                                                                \r\n\r\n<strong>Department of Cardiology, Tokat Gaziosmanpa\u015fa University, Tokat, Turkey\r\n\r\n<\/strong>    <br \/>                                                                            \r\nKay\u0131han Karaman<br \/>\r\nSefa Erdi \u00d6m\u00fcr\r\n<br \/><br \/>   \r\n  \r\n\r\n                [soshsc hide=\"logged\"]\r\n                <strong>You need to be <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/member-login\/\" target=\"_blank\" rel=\"noopener\">logged in to view and download<\/a> the full text PDF version. <a style=\"color: #c80c44;\" href=\"https:\/\/cvja.co.za\/journal\/register\/\" target=\"_blank\" rel=\"noopener\">Register for a free account?<\/a><\/strong> <br \/><br \/>[\/soshsc]\r\n                \r\n                \r\n                \r\n                <\/div>\r\n    \r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Acute decompensated heart failure (ADHF) exhibits a heterogeneous diuretic response. Chloride-bicarbonate imbalance may reduce loop diuretic efficiency. The effect of admission bicarbonate levels on diuretic resistance in unselected ADHF patients remains unclear. We aimed to evaluate whether higher admission bicarbonate identifies patients at risk of early diuretic dose escalation and less effective early decongestion.<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[44,111],"tags":[],"class_list":["post-5652","post","type-post","status-publish","format-standard","hentry","category-cardiovascular-topics","category-volume-37-issue-3"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Admission serum bicarbonate is associated with early diuretic resistance in acute decompensated heart failure - Cardiovascular Journal of Africa<\/title>\n<meta name=\"description\" content=\"Acute decompensated heart failure (ADHF) exhibits a heterogeneous diuretic response. Chloride-bicarbonate imbalance may reduce loop diuretic efficiency. The effect of admission bicarbonate levels on diuretic resistance in unselected ADHF patients remains unclear. We aimed to evaluate whether higher admission bicarbonate identifies patients at risk of early diuretic dose escalation and less effective early decongestion.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cvja.co.za\/journal\/cvja-2026-021\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Admission serum bicarbonate is associated with early diuretic resistance in acute decompensated heart failure - Cardiovascular Journal of Africa\" \/>\n<meta property=\"og:description\" content=\"Acute decompensated heart failure (ADHF) exhibits a heterogeneous diuretic response. Chloride-bicarbonate imbalance may reduce loop diuretic efficiency. The effect of admission bicarbonate levels on diuretic resistance in unselected ADHF patients remains unclear. We aimed to evaluate whether higher admission bicarbonate identifies patients at risk of early diuretic dose escalation and less effective early decongestion.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cvja.co.za\/journal\/cvja-2026-021\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiovascular Journal of Africa\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-31T09:32:37+00:00\" \/>\n<meta name=\"author\" content=\"Jaco Moolman\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jaco Moolman\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-021\/\",\"url\":\"https:\/\/cvja.co.za\/journal\/cvja-2026-021\/\",\"name\":\"Admission serum bicarbonate is associated with early diuretic resistance in acute decompensated heart failure - Cardiovascular Journal of Africa\",\"isPartOf\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/#website\"},\"datePublished\":\"2026-07-31T09:32:37+00:00\",\"author\":{\"@id\":\"https:\/\/cvja.co.za\/journal\/#\/schema\/person\/6bf8a30a039e93fd8112db707affb920\"},\"description\":\"Acute decompensated heart failure (ADHF) exhibits a heterogeneous diuretic response. 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