Acute decompensated heart failure (ADHF) accounts for more than 1 million hospital admissions annually and is associated with high morbidity and mortality. Decongestion with removal of increased total body sodium and total body water are goals of treatment. Acute kidney injury (AKI) or chronic kidney disease (CKD) is present in two-thirds of patients with ADHF. The pathophysiology of ADHF and AKI is bidirectional and synergistic. AKI and CKD complicate the management of ADHF by decreasing diuretic efficiency and excretion of sodium and water. Among patients hospitalized with ADHF, hyponatremia is the most common electrolyte abnormality and is classically encountered with volume overload. ADHF represents an additional therapeutic challenge particularly when oligoanuria is present. Predilution continuous venovenous hemofiltration with sodium-based osmotherapy can safely increase plasma sodium concentration without deleteriously increasing total body sodium. We present a detailed methodology that addresses the issue of hypervolemic hyponatremia in patients with ADHF and AKI.

急性失代偿性心力衰竭 (ADHF) 每年住院人数超过 100 万，并且与高发病率和死亡率相关。通过去除增加的全身钠和全身水来减轻充血是治疗的目标。三分之二的 ADHF 患者存在急性肾损伤 (AKI) 或慢性肾病 (CKD)。ADHF 和 AKI 的病理生理学是双向和协同的。AKI 和 CKD 通过降低利尿效率和钠和水的排泄使 ADHF 的管理复杂化。在因 ADHF 住院的患者中，低钠血症是最常见的电解质异常，通常会出现容量超负荷。ADHF 代表了一个额外的治疗挑战，特别是当存在少尿时。采用钠基渗透疗法的预稀释连续静脉静脉血液滤过可以安全地增加血浆钠浓度，而不会有害地增加全身钠。我们提出了一种详细的方法来解决 ADHF 和 AKI 患者的高容量性低钠血症问题。