Elsevier

JACC: Heart Failure

Volume 8, Issue 3, March 2020, Pages 199-208
JACC: Heart Failure

Mini-Focus Issue: MRAs and Diuretics
Clinical Research
Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center’s Experience

https://doi.org/10.1016/j.jchf.2019.10.012Get rights and content
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Abstract

Objectives

The purpose of this study was to investigate real world safety and efficacy of hypertonic saline therapy in cases of refractory acute decompensated heart failure (ADHF) at a large U.S. academic medical center.

Background

Hypertonic saline therapy has been described as a potential management strategy for refractory ADHF, but experience in the United States is limited.

Methods

A retrospective analysis was performed in all patients receiving hypertonic saline for diuretic therapy-resistant ADHF at the authors’ institution since March 2013. The primary analytic approach was a comparison of the trajectory of clinical variables prior to and after administration of hypertonic saline, with secondary focus on predictors of treatment response.

Results

A total of 58 hypertonic saline administration episodes were identified across 40 patients with diuretic-therapy refractory ADHF. Prior to hypertonic saline administration, serum sodium, chloride, and creatinine concentrations were worsening but improved after hypertonic saline administration (p < 0.001, all). Both total urine output and weight loss significantly improved with hypertonic saline (p = 0.01 and <0.001, respectively). Diuretic efficiency, defined as change in urine output per doubling of diuretic dose, also improved over this period (p < 0.01). There were no significant changes in respiratory status or overcorrection of serum sodium with the intervention.

Conclusions

In a cohort of patients who were refractory to ADHF, hypertonic saline administration was associated with increased diuretic efficiency, fluid and weight loss, and improvement of metabolic derangements, and no adverse respiratory or neurological signals were identified. Additional study of hypertonic saline as a diuretic adjuvant is warranted.

Key Words

cardiorenal
diuretic resistance
sodium regulation

Abbreviations and Acronyms

ADHF
acute decompensated heart failure
FiO2
fraction of inspired oxygen
HS
hypertonic saline
IQR
interquartile range
IV
intravenous
NaCl
sodium chloride
PO
taken by mouth

Cited by (0)

Supported by U.S. National Institutes of Health grants K23HL114868, L30HL115790, R01HL139629, R21HL143092, R01HL128973 (to J.M.T.); R01DK113191 and P30DK079210 (to Dr. Wilson); and 5T32HL007950 (to Dr. Griffin). Dr. Riello is a consultant for Janssen, Johnson & Johnson, Portola, Medicure, and AstraZeneca. Dr. Coca is a consultant for RenalytixAI, CHF Solutions, Takeda, and Bayer; and has equity in RenalyitxAI. Dr. Testani has received research funding from Sequana Medical, 3ive Labs, Cardionomic, Bayer, Boehringer Ingelheim, MagentaMed, Otsuka, Sanofi, FIRE1, and Abbott; and is a consultant for Bristol-Myers Squibb AstraZeneca, Novartis, 3ive Labs, Cardionomic, Bayer, Boehringer Ingelheim, MagentaMed, Reprieve Medical, Sanofi, FIRE1, and W.L. Gore. Dr. Tang has received consulting fees for Sequana. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Drs. Griffin and Soufer are joint first authors.