Furosemide and spironolactone doses and hyponatremia in patients with heart failure

Abstract

Background: Hyponatremia, a marker of disease severity and prognosis, has been associated with various clinical factors and drug use, especially diuretics. Methods: This observational prospective cohort study enrolled patients hospitalized at the University Hospital Center Split because of heart failure (HF). We investigated the association of clinical variables and cardiovascular drugs, including furosemide, hydrochlorothiazide, spironolactone, and their doses, with the presence of hyponatremia at admission. Results: Of the 565 included patients, 32.4% were hyponatremic, 62.6% were males, and the mean age was 73.1 ± 10.6 years. In the univariate analysis, hyponatremic patients were more often current smokers (p = 0.01), alcohol consumers (p = 0.01), receiving spironolactone (p = 0.004) or combination of furosemide and spironolactone (p = 0.003). Patients who received 50 and 100 mg of spironolactone, compared to those receiving 25 mg (p < 0.0001), as well as patients who received 250 to 500 mg of furosemide compared to ≤240 mg (p = 0.001), were significantly more often hyponatremic. In the multivariate analysis, when diuretic doses were accounted for, furosemide doses of 250 to 500 mg (p = 0.009), spironolactone doses of 50 to 100 mg (p = 0.0003), increasing age (p = 0.03), diabetes mellitus (p = 0.02) and alcohol consumption (p = 0.04) were independently associated with hyponatremia. Conclusion: High doses of furosemide and spironolactone, or concomitant use of these diuretics, seem to be an important cause of hyponatremia in HF patients, particularly in combination with advanced age, diabetes and alcohol consumption. Diuretic dose reduction may help avoid hyponatremia and improve clinical status and prognosis in such patients.

Efficacy of tolvaptan on advanced chronic kidney disease with heart failure: a randomized controlled trial

“…Hyponatremia is considered to be one of the important causes of poor prognosis in patients with heart failure [ 28 ], and thus prevention of its onset is important. FUR has been reported to cause hyponatremia in a dose-dependent manner [ 29 ], and unfortunately, the serum sodium concentration was significantly decreased by increasing the dose of FUR in this study as well. On the other hand, with the addition of TLV, which is a water diuretic, mild elevation of serum sodium was observed in patients with a tendency toward hyponatremia.…”

A Retrospective Study to Determine the Side Effects and Complications Associated with the Usage of Loop Diuretics in ADHF or Left Ventricular Heart Failure Patients

“…Several clinical conditions and cardiovascular risk factors, such as diabetes mellitus, chronic obstructive pulmonary disease, and alcohol consumption may also be associated with hyponatremia. A similar study by Velat Ivan et al 6 reveals that high doses of furosemide and spironolactone, or concomitant use of these diuretics, seem to be an important cause of hyponatremia in HF patients, particularly in combination with advanced age, diabetes, and alcohol consumption. Diuretic dose reduction may help to avoid hyponatremia and improve clinical status and prognosis in such patients.…”

Hyponatremia and Renal Venous Congestion in Heart Failure Patients

“…Kiliçkiran Avci et al reported that LVEF is lower in hyponatremic HF group of patients than in normonatremic one ( p ≤ 0.002) [ 23 ]. In another study, published by Velat et al, it was identified that among HF patients with LVEF ≤ 45% hyponatremia was present in 48.1% of them, while normal serum natremia was present in 37.7% ( p = 0.02) [ 24 ].…”

“…In the study performed by Velat et al, NT-proBNP levels, marker of HF severity, were significantly higher in hyponatremic than in nonhyponatremic HF patients ( p = 0.006). Levels of NT-proBNP levels presented inverse significantly correlations with the glomerular filtration rate and LVEF [ 24 ].…”