Hypertonic Saline Solution

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Editorial

Diuretic in Decompensated Heart Failure: With or Without Salt?

Acute or decompensated heart failure (HF) syndrome is a common cause of admission to emergency rooms or HF clinics. Patients often present in profile “B” of the hemodynamic classification and have low therapeutic adherence as the cause of their decompensation. In this clinical situation, the use of high-dose intravenous loop diuretics has been the mainstay of treatment over the last five decades. It does not change the long-term prognosis of the underlying disease, but it moves the patient from the acute crisis to outpatient compensation.

There are many issues involved in diuretic therapy for decongestion. There are questions about doses; continuous infusion or bolus; parameters for complete decongestion; and care to avoid hypovolemia. Resistance to diuretics and sodium craving are mechanisms present in more severe and chronic patients, making decongestion even more challenging. Fortunately, some solutions to the problems mentioned above have been proposed and tested.

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Original Article

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

Tugce Colluoglu et al. Tuğba Kapanşahin Melahat Hicran Aksu Orhan Önalan Yeşim Akin

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 1^st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2^nd 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.