The Effect of Early Administration of Hypertonic Saline Solution İn Acute Decompensated Heart Failure

Abstract

Background: There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF).

Objectives: This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes.

Methods: In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%.

Results: The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups.

Conclusion: HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients.

Figura Central. : O Efeito da Administração Precoce de Solução Salina Hipertônica na Insuficiência Cardíaca Descompensada Aguda

Figura 1. – Fluxograma. &: Em casos de resposta inadequada a diuréticos de alça IV, a dose de diuréticos de alça IV é aumentada duas vezes. *: A hospitalização por insuficiência cardíaca e a mortalidade por todas as causas foram avaliadas nos primeiros 6 meses após a hospitalização índice. TFGe: taxa de filtração glomerular estimada; IV: intravenoso; SSH: solução salina hipertônica; ICA: insuficiência cardíaca agudamente descompensada; DA: diurético de alça; BUN: nitrogênio na urina no sangue; Cr: creatinina; BNP: peptídeo natriurético cerebral; Htc: hematócrito.

Central Illustration. : The Effect of Early Administration of Hypertonic Saline Solution İn Acute Decompensated Heart Failure

Figure 1. – Flow chart. &: In cases of inadequate response to iv.loop diuretics, the dose of iv.loop diuretics is increased twofold. * Hospitalization for heart failure and all-cause mortality were evaluated in the first 6 months after index hospitalization. eGFR: estimated glomerular filtration rate; IV: intravenous; HSS: hypertonic salin solution; AHF: acutely decompensated heart failure; LD: loop diuretic; BUN: blood urine nitrogen; Cr: creatinine; BNP: brain natriuretic peptide; Htc: hematocrit.