Author + information
- Received September 19, 2019
- Accepted October 20, 2019
- Published online February 24, 2020.
- Matthew Griffin, MDa,∗,
- Aaron Soufer, MDa,∗,
- Erden Goljo, MDb,
- Matthew Colna, MDc,
- Veena S. Rao, PhDa,
- Sangchoon Jeon, PhDd,
- Parinita Raghavendra, BSa,
- Julie D’Ambrosi, PharmDe,
- Ralph Riello, PharmDe,
- Steven G. Coca, DO, MSf,
- Devin Mahoney, BSa,
- Daniel Jacoby, MDa,
- Tariq Ahmad, MD, MPHa,
- Michael Chen, MDa,
- W.H. Wilson Tang, MDg,
- Jeffrey Turner, MDh,
- Wilfried Mullens, MD, PhDi,j,
- Francis P. Wilson, MD, MSCEh and
- Jeffrey M. Testani, MD, MTRa,∗ ()
- aSection of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- bDepartment of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- cDepartment of Internal Medicine, Norwalk Hospital, Norwalk, Connecticut
- dYale School of Nursing, West Haven, Connecticut
- eDepartment of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut
- fDepartment of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- gDepartment of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- hSection of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- iDepartment of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
- jBiomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University Diepenbeek, Belgium
- ↵∗Address for correspondence:
Dr. Jeffrey M. Testani, Section of Cardiovascular Medicine, Yale School of Medicine, 135 College Street, Suite 230, New Haven, Connecticut 06520.
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.
↵∗ Drs. Griffin and Soufer are joint first authors.
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.
- Received September 19, 2019.
- Accepted October 20, 2019.
- 2020 American College of Cardiology Foundation
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