Actively Recruiting
Spot Analysis of Natriuresis to Guide Up- or Down-Titration of Diuretic Therapy in Ambulatory Patients With Chronic Heart Failure (SAND-HF)
Led by Cardiology Research UBC · Updated on 2026-03-27
300
Participants Needed
1
Research Sites
30 weeks
Total Duration
On this page
AI-Summary
What this Trial Is About
Heart failure is a long-term condition that causes fluid buildup and frequent hospital visits. This research evaluates using spot urine sodium measurements to help guide the adjustment of loop diuretic doses in patients with heart failure. The study aims to assess if this method is practical and useful compared to usual clinical judgment. It is a pilot study involving three groups of ambulatory patients with different congestion statuses. Participants are divided into three groups. Group 1 includes patients with signs of congestion and will be randomized to either natriuresis-guided up-titration of diuretics or standard care. Group 2 involves stable patients who may safely reduce diuretics and will be randomized to either natriuresis-guided down-titration or standard care. Group 3 consists of patients who do not meet criteria for Groups 1 or 2 and will be observed without intervention. Urine sodium is measured at baseline and follow-up visits, with diuretic doses adjusted according to predefined rules for those in the randomized groups. Participants will be monitored over 90 days with assessments including urine sodium levels, congestion scores, symptom questionnaires, weight, kidney function, and medication use. The study evaluates feasibility by looking at recruitment, retention, adherence to urine sampling, and workflow. Clinical outcomes and usability of the urine sodium-guided approach will also be recorded to help plan a larger trial. Participants receive routine clinical follow-up, with some having diuretic doses adjusted based on urine sodium measurements.
CONDITIONS
Brief Title
Spot Analysis of Natriuresis to Guide up- or Down-titration of Diuretic Therapy in Ambulatory Patients With Chronic Heart Failure
Who Can Participate
Eligibility Criteria
You may qualify if you...
- Age 18 years or older
- Diagnosis of heart failure according to the Universal Definition
- Use of loop diuretics
- Residing in VCH or PHC healthcare regions
- Group 1: Congestion score 5 or higher OR objective evidence of congestion; stable furosemide use for at least 1 week
- Group 2: New York Heart Association class I-II; congestion score less than 5; no recent heart failure hospitalization; stable furosemide use for at least 1 month
- Group 3: First 100 eligible patients not meeting criteria for Groups 1 or 2
You will not qualify if you...
- Estimated glomerular filtration rate less than 20 mL/min/1.73m2
- Receiving renal replacement therapy such as dialysis
- High-risk clinical condition requiring hospitalization
- Unable to consent or perform required urine sampling
AI-Screening
AI-Powered Screening
Complete this quick 3-step screening to check your eligibility
Your Study Journey
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - Up to 90 days
Participants receive diuretic dose adjustments guided by urine sodium measurements or standard clinical management based on their assigned group. This includes up-titration or down-titration of diuretics using predefined algorithms or usual care without urine sodium-guided adjustments.
Baseline visit and follow-up visits over 90 days
Duration - Up to 90 days
Participants who do not meet criteria for active treatment cohorts undergo baseline urine sodium assessment and routine clinical follow-up without study-directed diuretic titration.
Baseline visit and routine follow-up visits over 90 days
Trial Site Locations
Total: 1 location
1
Vancouver General Hospital
Vancouver, British Columbia, Canada
Actively Recruiting
Research Team
N
Natalie Bloch, MD
How is the study designed?
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
5
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