The impact of volume and sodium chloride supplementation on diuretic response during decongestion of decompensated heart failure patients
G Iwanek, R Zymlinski, M Guzik, P Gajewski, J Nunez, R Tymkow, J Testani, P Ponikowski, J BiegusAbstract
Background
For many years, fluid and sodium restriction have been considered essential strategies for achieving effective decongestion in acute heart failure (AHF); however, this paradigm has recently been questioned.
Purpose
This analysis aims to evaluate and compare the effectiveness of three different fluid strategies for decongestion: no fluid, fluid with sodium/chloride, and fluid without sodium/chloride in AHF.
Methods
This post-hoc analysis of two prospective, single-center, mechanistic studies included 55 patients with AHF and fluid overload. All patients received standardized furosemide dosing. A total of 21 patients received a continuous infusion of 0.9% NaCl (83 mL/h), 19 patients received 5% glucose (83 mL/h), and 15 did not receive any fluids. The primary outcome is urine volume and natriuresis at 6 hours after loop diuretic administration.
Results
There was a significant difference in cumulative (6 hours) net natriuresis between patients receiving fluid therapy (n=40) and those without fluid therapy (n=15) (139 [66-264] mmol vs. 79 [15-144]mmol, p=0.043). There was no significant difference in cumulative net diuresis between these groups (1170 [880-1890]mL vs. 1010 [475-1270]mL, p = 0.078), respectively.
The NaCl group had a better diuretic response when compared to the glucose and no fluids groups (absolute: 1980 [1620-3150]mL vs. 1510 [1075-2175]mL vs. 1010 [475-1270]mL, p<0.001, net: 1480 [1120-2650]mL vs. 1010 [575-1675]mL vs. 1010 [475-1270]mL, p=0.019, respectively) but the difference in natriuresis did not meet statistical significance (p=0.126).
Conclusions
Intravenous fluid replacement during decongestion in patients with AHF was associated with increased net natriuresis and a trend toward higher urine output, with a significant augmentation of diuresis with sodium chloride supplementation.Graphical AbstractFor image description, please refer to the figure legend and surrounding text.