Jef Van den Eynde
@jefvandeneynde.bsky.social
Internal Medicine Resident & Researcher #KULeuven | #HopkinsMedicine, #BAEF, #lindaunobel alumnus | #Cardiology #CHD #ACHD #HF #Medicine
✍️ Writing this review was a true pleasure.
We hope it brings you as much insight as it brought us joy.
May it inspire fresh thinking, open debate, and new paths in HF decongestion.
Disagree freely - dialogue is how we move forward.
💡🫀 #heartfailure
We hope it brings you as much insight as it brought us joy.
May it inspire fresh thinking, open debate, and new paths in HF decongestion.
Disagree freely - dialogue is how we move forward.
💡🫀 #heartfailure
June 19, 2025 at 7:25 PM
✍️ Writing this review was a true pleasure.
We hope it brings you as much insight as it brought us joy.
May it inspire fresh thinking, open debate, and new paths in HF decongestion.
Disagree freely - dialogue is how we move forward.
💡🫀 #heartfailure
We hope it brings you as much insight as it brought us joy.
May it inspire fresh thinking, open debate, and new paths in HF decongestion.
Disagree freely - dialogue is how we move forward.
💡🫀 #heartfailure
🔬 Dive into the full review by Frederik Verbrugge and myself in Eur J Heart Fail (2025):
📄 “Water and electrolyte homeostasis during decongestion in heart failure”
🧠 A must-read for anyone treating HF. onlinelibrary.wiley.com/doi/10.1002/...
#medsky #cardiosky #cardiology #meded
📄 “Water and electrolyte homeostasis during decongestion in heart failure”
🧠 A must-read for anyone treating HF. onlinelibrary.wiley.com/doi/10.1002/...
#medsky #cardiosky #cardiology #meded
onlinelibrary.wiley.com
June 19, 2025 at 7:25 PM
🔬 Dive into the full review by Frederik Verbrugge and myself in Eur J Heart Fail (2025):
📄 “Water and electrolyte homeostasis during decongestion in heart failure”
🧠 A must-read for anyone treating HF. onlinelibrary.wiley.com/doi/10.1002/...
#medsky #cardiosky #cardiology #meded
📄 “Water and electrolyte homeostasis during decongestion in heart failure”
🧠 A must-read for anyone treating HF. onlinelibrary.wiley.com/doi/10.1002/...
#medsky #cardiosky #cardiology #meded
🧠 Take-home pearls:
📌 HF: Na⁺ > water retention, K⁺ depletion
📌 Diuretics: further depletion of water, K⁺ and Cl⁻
📌 Balanced diuresis compensates for these losses and restores homeostasis
Aim for 🧪 physiology-guided decongestion - not just diuresis!
📌 HF: Na⁺ > water retention, K⁺ depletion
📌 Diuretics: further depletion of water, K⁺ and Cl⁻
📌 Balanced diuresis compensates for these losses and restores homeostasis
Aim for 🧪 physiology-guided decongestion - not just diuresis!
June 19, 2025 at 7:25 PM
🧠 Take-home pearls:
📌 HF: Na⁺ > water retention, K⁺ depletion
📌 Diuretics: further depletion of water, K⁺ and Cl⁻
📌 Balanced diuresis compensates for these losses and restores homeostasis
Aim for 🧪 physiology-guided decongestion - not just diuresis!
📌 HF: Na⁺ > water retention, K⁺ depletion
📌 Diuretics: further depletion of water, K⁺ and Cl⁻
📌 Balanced diuresis compensates for these losses and restores homeostasis
Aim for 🧪 physiology-guided decongestion - not just diuresis!
🛠️ How do we get there?
🧃 Liberal water intake
🧂 KCl over K-citrate/gluconate for dual K⁺ + Cl⁻ support
💊 Early acetazolamide and SGLT2i to reduce Cl⁻ loss
🧪 Use urine Na⁺ to guide decongestion & aim for 150-250mmmol net Na⁺ removal per 1kg above "dry weight"
🧃 Liberal water intake
🧂 KCl over K-citrate/gluconate for dual K⁺ + Cl⁻ support
💊 Early acetazolamide and SGLT2i to reduce Cl⁻ loss
🧪 Use urine Na⁺ to guide decongestion & aim for 150-250mmmol net Na⁺ removal per 1kg above "dry weight"
June 19, 2025 at 7:25 PM
🛠️ How do we get there?
🧃 Liberal water intake
🧂 KCl over K-citrate/gluconate for dual K⁺ + Cl⁻ support
💊 Early acetazolamide and SGLT2i to reduce Cl⁻ loss
🧪 Use urine Na⁺ to guide decongestion & aim for 150-250mmmol net Na⁺ removal per 1kg above "dry weight"
🧃 Liberal water intake
🧂 KCl over K-citrate/gluconate for dual K⁺ + Cl⁻ support
💊 Early acetazolamide and SGLT2i to reduce Cl⁻ loss
🧪 Use urine Na⁺ to guide decongestion & aim for 150-250mmmol net Na⁺ removal per 1kg above "dry weight"
💊 So, what should we aim for?
“Balanced Diuresis” means:
✅ Remove Na⁺ effectively (natriuresis!)
✅ Preserve Cl⁻ & K⁺
✅ Prevent intracellular dehydration
💧 Net fluid loss is not enough - composition matters.
“Balanced Diuresis” means:
✅ Remove Na⁺ effectively (natriuresis!)
✅ Preserve Cl⁻ & K⁺
✅ Prevent intracellular dehydration
💧 Net fluid loss is not enough - composition matters.
June 19, 2025 at 7:25 PM
💊 So, what should we aim for?
“Balanced Diuresis” means:
✅ Remove Na⁺ effectively (natriuresis!)
✅ Preserve Cl⁻ & K⁺
✅ Prevent intracellular dehydration
💧 Net fluid loss is not enough - composition matters.
“Balanced Diuresis” means:
✅ Remove Na⁺ effectively (natriuresis!)
✅ Preserve Cl⁻ & K⁺
✅ Prevent intracellular dehydration
💧 Net fluid loss is not enough - composition matters.
🧬 Cl⁻: the forgotten ion.
Cl⁻:
🔹 Senses volume status at the macula densa
🔹 Regulates acid–base via the strong ion difference (SID)
🔹 Modulates neurohormonal feedback
💥 HypoCl⁻ = diuretic resistance + reduction in effective circulating volume
Cl⁻:
🔹 Senses volume status at the macula densa
🔹 Regulates acid–base via the strong ion difference (SID)
🔹 Modulates neurohormonal feedback
💥 HypoCl⁻ = diuretic resistance + reduction in effective circulating volume
June 19, 2025 at 7:25 PM
🧬 Cl⁻: the forgotten ion.
Cl⁻:
🔹 Senses volume status at the macula densa
🔹 Regulates acid–base via the strong ion difference (SID)
🔹 Modulates neurohormonal feedback
💥 HypoCl⁻ = diuretic resistance + reduction in effective circulating volume
Cl⁻:
🔹 Senses volume status at the macula densa
🔹 Regulates acid–base via the strong ion difference (SID)
🔹 Modulates neurohormonal feedback
💥 HypoCl⁻ = diuretic resistance + reduction in effective circulating volume
🧪 Why does K⁺ matter?
🧠 K⁺ maintains key cellular functions and is the predominant intracellular osmolyte.
In HF:
📉 TEK⁺ (total exchangeable K⁺) is reduced
⬇️ Buffer capacity for K⁺ fluctuations
🔁 Risk of hypoK⁺ → ↑mortality, ↑arrhythmia, ↑diuretic resistance
🧠 K⁺ maintains key cellular functions and is the predominant intracellular osmolyte.
In HF:
📉 TEK⁺ (total exchangeable K⁺) is reduced
⬇️ Buffer capacity for K⁺ fluctuations
🔁 Risk of hypoK⁺ → ↑mortality, ↑arrhythmia, ↑diuretic resistance
June 19, 2025 at 7:25 PM
🧪 Why does K⁺ matter?
🧠 K⁺ maintains key cellular functions and is the predominant intracellular osmolyte.
In HF:
📉 TEK⁺ (total exchangeable K⁺) is reduced
⬇️ Buffer capacity for K⁺ fluctuations
🔁 Risk of hypoK⁺ → ↑mortality, ↑arrhythmia, ↑diuretic resistance
🧠 K⁺ maintains key cellular functions and is the predominant intracellular osmolyte.
In HF:
📉 TEK⁺ (total exchangeable K⁺) is reduced
⬇️ Buffer capacity for K⁺ fluctuations
🔁 Risk of hypoK⁺ → ↑mortality, ↑arrhythmia, ↑diuretic resistance
⚠️ Diuretics are indispensable tools, but they are physiologically clumsy.
They cause:
🥵 Electrolyte-free water loss (mostly from intracellular compartments)
🧂 Disproportionate Cl⁻ excretion
⚡ Further K⁺ depletion
🚱 And with fluids? Intracellular dehydration worsens.
They cause:
🥵 Electrolyte-free water loss (mostly from intracellular compartments)
🧂 Disproportionate Cl⁻ excretion
⚡ Further K⁺ depletion
🚱 And with fluids? Intracellular dehydration worsens.
June 19, 2025 at 7:25 PM
⚠️ Diuretics are indispensable tools, but they are physiologically clumsy.
They cause:
🥵 Electrolyte-free water loss (mostly from intracellular compartments)
🧂 Disproportionate Cl⁻ excretion
⚡ Further K⁺ depletion
🚱 And with fluids? Intracellular dehydration worsens.
They cause:
🥵 Electrolyte-free water loss (mostly from intracellular compartments)
🧂 Disproportionate Cl⁻ excretion
⚡ Further K⁺ depletion
🚱 And with fluids? Intracellular dehydration worsens.
🔄 The Na⁺ story gets even more interesting:
HF causes:
🔹 Intracellular Na⁺ shifts
🔹 Extracellular Na⁺ buffering by glycosaminoglycans (GAGs)
🔹 Displacement of K⁺, Mg²⁺, H⁺
💣 Net result: electrolyte imbalance + loss of cellular osmolytes.
HF causes:
🔹 Intracellular Na⁺ shifts
🔹 Extracellular Na⁺ buffering by glycosaminoglycans (GAGs)
🔹 Displacement of K⁺, Mg²⁺, H⁺
💣 Net result: electrolyte imbalance + loss of cellular osmolytes.
June 19, 2025 at 7:25 PM
🔄 The Na⁺ story gets even more interesting:
HF causes:
🔹 Intracellular Na⁺ shifts
🔹 Extracellular Na⁺ buffering by glycosaminoglycans (GAGs)
🔹 Displacement of K⁺, Mg²⁺, H⁺
💣 Net result: electrolyte imbalance + loss of cellular osmolytes.
HF causes:
🔹 Intracellular Na⁺ shifts
🔹 Extracellular Na⁺ buffering by glycosaminoglycans (GAGs)
🔹 Displacement of K⁺, Mg²⁺, H⁺
💣 Net result: electrolyte imbalance + loss of cellular osmolytes.
💡 In HF, Na⁺ is retained out of proportion to water.
📊 TENa⁺ (total exchangeable Na⁺) increases > TBW (total body water).
In fact, Na⁺ retention is the primary culprit in HF; water retention is a secondary phenomenon!
Most Na⁺ accumulates in the extracellular space.
📊 TENa⁺ (total exchangeable Na⁺) increases > TBW (total body water).
In fact, Na⁺ retention is the primary culprit in HF; water retention is a secondary phenomenon!
Most Na⁺ accumulates in the extracellular space.
June 19, 2025 at 7:25 PM
💡 In HF, Na⁺ is retained out of proportion to water.
📊 TENa⁺ (total exchangeable Na⁺) increases > TBW (total body water).
In fact, Na⁺ retention is the primary culprit in HF; water retention is a secondary phenomenon!
Most Na⁺ accumulates in the extracellular space.
📊 TENa⁺ (total exchangeable Na⁺) increases > TBW (total body water).
In fact, Na⁺ retention is the primary culprit in HF; water retention is a secondary phenomenon!
Most Na⁺ accumulates in the extracellular space.
A huge congratulations to our lead author Hannah Van Belle, supervisor Alexander Van De Bruaene, and all the amazing co-authors who made this work possible. Your dedication and teamwork were instrumental!
December 22, 2024 at 2:16 PM
A huge congratulations to our lead author Hannah Van Belle, supervisor Alexander Van De Bruaene, and all the amazing co-authors who made this work possible. Your dedication and teamwork were instrumental!
This step is crucial for understanding and addressing the full impact of kidney disease in this population.
December 22, 2024 at 2:16 PM
This step is crucial for understanding and addressing the full impact of kidney disease in this population.
In this study, we found that albuminuria affects up to one-third of Fontan patients, emphasizing the need to incorporate the urine albumin-to-creatinine ratio (UACR) into chronic kidney disease classifications.
December 22, 2024 at 2:16 PM
In this study, we found that albuminuria affects up to one-third of Fontan patients, emphasizing the need to incorporate the urine albumin-to-creatinine ratio (UACR) into chronic kidney disease classifications.
Would love to be added! Great initiative!
November 30, 2024 at 8:52 PM
Would love to be added! Great initiative!