Hypertonic saline with furosemide for the treatment of acute congestive heart failure: A systematic review and meta-analysis

Gandhi, Sumeet; Mosleh, Wassim; Myers, Robert B.H.

doi:10.1016/j.ijcard.2014.03.020

Cited by 61 publications

(30 citation statements)

References 23 publications

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“…The combination of hypertonic saline with high loop diuretic doses has been proposed to mitigate renal dysfunction and promote natriuresis, 75 although this has not yet been tested in a robust trials. Finally, furosemide has been reformulated for subcutaneous delivery, which may allow delivery of “IV-like” diuresis outside of the hospital setting, with potentially important implications for care delivery and cost.…”

Section: Introductionmentioning

confidence: 99%

Diuretic Treatment in Heart Failure

2017

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Section: Introductionmentioning

confidence: 99%

Diuretic Treatment in Heart Failure

2017

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“…Supplementation of additional chloride may be an alternative approach to normalizing chloride stores and possibly improving outcomes. Some possible support for this hypothesis is provided by the counterintuitive findings that administration of additional sodium chloride, either by diet or intravenously, paradoxically leads to either no change or an actual improvement in diuresis, renal function, rehospitalization, and death in several small studies . Given that the primary goal in the majority of decompensated heart failure hospitalizations is removal of sodium and fluid from the patient, the direct effect of additional sodium administration is intuitively counterproductive.…”

Section: Discussionmentioning

confidence: 99%

Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure

Testani

Hanberg

Arroyo

et al. 2016

European J of Heart Fail

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Aims Hyponatraemia is strongly associated with adverse outcomes in heart failure. However, accumulating evidence suggests that chloride may play an important role in renal salt sensing and regulation of neurohormonal and sodium-conserving pathways. Our objective was to determine the prognostic importance of hypochloraemia in patients with heart failure. Methods and results Patients in the BEST trial with baseline serum chloride values were evaluated (n = 2699). Hypochloraemia was defined as a serum chloride ≤96 mmol/L and hyponatraemia as serum sodium ≤135 mmol/L. Hypochloraemia was present in 13.0% and hyponatraemia in 13.7% of the population. Chloride and sodium were only modestly correlated (r = 0.53), resulting in only 48.7% of hypochloraemic patients having concurrent hyponatraemia. Both hyponatraemia and hypochloraemia identified a population with greater disease severity; however, renal function tended to be worse and loop diuretic doses higher with hypochloraemia. In univariate analysis, lower serum sodium or serum chloride as continuous parameters were each strongly associated with mortality (P < 0.001). However, when both parameters were included in the same model, serum chloride remained strongly associated with mortality [hazard ratio (HR) 1.3 per standard deviation decrease, 95% confidence interval (CI) 1.18–1.42, P < 0.001], whereas sodium was not (HR 0.97 per standard deviation decrease, 95% CI 0.89–1.06, P = 0.52). Conclusion Serum chloride is strongly and independently associated with worsened survival in patients with chronic heart failure and accounted for the majority of the risk otherwise attributable to hyponatraemia. Given the critical role of chloride in a number of regulatory pathways central to heart failure pathophysiology, additional research is warranted in this area.

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“…Patients who receive normal saline early during hospitalization for HF experience higher rates of requirement for renal replacement and death . In contrast, use of hypertronic saline as an adjunct to loop diuretics may augment volume removal, and has been associated with improvements in short‐term clinical outcomes . The role of chloride supplementation, including administration of sodium‐free chloride salts, requires further investigation.…”

Section: Serum Chloride In Heart Failure: a Target For Therapy?mentioning

confidence: 99%