Natriuresis-Guided Diuretic Therapy in Patients With Acute Heart Failure With Reduced Ejection Fraction and Chronic Kidney Disease

Inclusion Criteria: * Patients presenting with acute heart failure (AHF) with reduced ejection fraction either De novo or ADHF. * Patients with chronic kidney disease (CKD) stages 1-4. * Patients aged 18 years or older. * Patients accept to participate in the study. Exclusion Criteria: * Patients with significant stenotic valvular diseases (MS, AS). * Patients with acute coronary syndrome. * Patients with acute cardiogenic shock. * Patients with dyspnea primarily due to non-cardiac cause (significant COPD). * Patients with severe renal impairment requiring dialysis (GFR \< 15 mL/min/1.73 m²).