Hyponatraemia in heart failure: time for new solutions?

Kapłon‐Cieślicka, Agnieszka; Soloveva, A.; Mareev, Yura; Cabac-Pogorevici, Irina; Verbrugge, Frederik H.; Vardas, Panagiotis

doi:10.1136/heartjnl-2021-320277

Cited by 5 publications

(21 citation statements)

References 49 publications

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“…1-10 Hyponatraemia in HF is generally dilutional and increases with the severity of HF. 5,6,21 In our analysis of a large number of potential risk markers, we confirm the association with more advanced HF but offer some granular observations. In general, factors associated with admission and persistent hyponatraemia were markers associated with more advanced HF such as haemodilution, lower SBP, EF and eGFR, higher NYHA class and NT-proBNP, larger left ventricular diameter, more mitral and tricuspid regurgitation and more restrictive/pseudonormal mitral inflow pattern.…”

Section: Associations With Hyponatraemia At Admission and Sodium Chan...supporting

confidence: 68%

“…[1][2][3][4][5][6][7][8][9][10] In acute HF (AHF), hyponatraemia is mainly dilutional and results from venous congestion and poor perfusion, and elevated vasopressin concentrations leading to free water retention. 5 It reflects neurohormonalactivation, fluid retention, and . .…”

Section: Introductionmentioning

confidence: 99%

“…congestion, and is associated with worse in-hospital and long-term prognosis. [1][2][3][4][5][6][7][8] Up to a half of HF patients suffer from frequent thirst, which results from neurohormonal activation and HF treatment, and may lead to increased fluid intake. 11,12 Limited data are available regarding risk markers and risk factors for hyponatraemia at AHF hospitalization and the associations between changes of sodium concentration during hospitalization and post-discharge prognosis in HF.…”

Section: Introductionmentioning

confidence: 99%

“…3,10 Still, although the vasopressin receptor blocker tolvaptan appears effective in correcting hyponatraemia and reducing congestion, it had no effect on long-term mortality or HF-related morbidity in AHF. 5,6,9 While aggressive diuresis in AHF may also lead to depletional hyponatraemia due to sodium losses, its effects on long-term outcomes remain unknown. 13,14 The aim of this analysis was to assess hyponatraemia and serum sodium changes during hospitalization for AHF irrespective of ejection fraction (EF) with regard to prevalence, predictors, in-hospital clinical course and mortality, and post-discharge outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in‐hospital and long‐term outcomes – from the ESC‐HFA EORP Heart Failure Long‐Term Registry

Benson

Crespo‐Leiro

Ruschitzka

et al. 2023

European J of Heart Fail

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AimsTo comprehensively assess hyponatraemia in acute heart failure (AHF) regarding prevalence, associations, hospital course, and post‐discharge outcomes.Methods and resultsOf 8298 patients in the European Society of Cardiology Heart Failure Long‐Term Registry hospitalized for AHF with any ejection fraction, 20% presented with hyponatraemia (serum sodium <135 mmol/L). Independent predictors included lower systolic blood pressure, estimated glomerular filtration rate (eGFR) and haemoglobin, along with diabetes, hepatic disease, use of thiazide diuretics, mineralocorticoid receptor antagonists, digoxin, higher doses of loop diuretics, and non‐use of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and beta‐blockers. In‐hospital death occurred in 3.3%. The prevalence of hyponatraemia and in‐hospital mortality with different combinations were: 9% hyponatraemia both at admission and discharge (hyponatraemia Yes/Yes, in‐hospital mortality 6.9%), 11% Yes/No (in‐hospital mortality 4.9%), 8% No/Yes (in‐hospital mortality 4.7%), and 72% No/No (in‐hospital mortality 2.4%). Correction of hyponatraemia was associated with improvement in eGFR. In‐hospital development of hyponatraemia was associated with greater diuretic use and worsening eGFR but also more effective decongestion. Among hospital survivors, 12‐month mortality was 19% and adjusted hazard ratios (95% confidence intervals) were for hyponatraemia Yes/Yes 1.60 (1.35–1.89), Yes/No 1.35 (1.14–1.59), and No/Yes 1.18 (0.96–1.45). For death or heart failure hospitalization they were 1.38 (1.21–1.58), 1.17 (1.02–1.33), and 1.09 (0.93–1.27), respectively.ConclusionAmong patients with AHF, 20% had hyponatraemia at admission, which was associated with more advanced heart failure and normalized in half of patients during hospitalization. Admission hyponatraemia (possibly dilutional), especially if it did not resolve, was associated with worse in‐hospital and post‐discharge outcomes. Hyponatraemia developing during hospitalization (possibly depletional) was associated with lower risk.

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Section: Associations With Hyponatraemia At Admission and Sodium Chan...supporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in‐hospital and long‐term outcomes – from the ESC‐HFA EORP Heart Failure Long‐Term Registry

Benson

Crespo‐Leiro

Ruschitzka

et al. 2023

European J of Heart Fail

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“…The efficacy and safety of SGLT2i have also been demonstrated in several studies with AHF [4]. The potential impact of SGLT2i on sodium homeostasis is worth studying [5], so the aim of this research was to clarify the effect of SGLT2i on serum sodium concentrations in AHF patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of Dapagliflozin Treatment on Serum Sodium Concentrations in Acute Heart Failure

et al. 2023

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Introduction The dynamics of serum sodium are important in acute heart failure (AHF), and hyponatremia is associated with a poor prognosis. The effect of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) on serum sodium concentrations in AHF is unknown. Methods In a single-centre, controlled, randomized study, patients were prescribed dapagliflozin in addition to standard treatment during the first 24 hours of hospitalization, versus standard treatments. The pre-specified outcome was an absolute change in plasma sodium concentrations between randomization (first 24 hours after admission) and discharge. The secondary outcomes were an absolute change in serum sodium concentrations within 48 hours of randomization, and the persistence of hyponatremia. Results The sample comprised 285 patients (53% males; average age 73.26 ± 13 years); 140 of these were randomized to the dapagliflozin group. The average ejection fraction (EF) was 46 ± 14%; 155 patients (54%) had ischaemic heart failure; and 35% had diabetes mellitus. Median N-terminal pro b-type natriuretic peptide (NT-proBNP) was 4225 [2120; 9105] pg/ml. The average estimated glomerular filtration rate (eGFR) was 53.9 ± 17.2 ml/min. Hospital mortality was 6.7%. At randomization, serum sodium concentrations were 139.8 ± 4.32 mmol/l in the dapagliflozin group vs. 140.85 ± 4.04 mmol/l in the control group; р = 0.048. 48 hours later, there was an increase in serum sodium in the dapagliflozin group (2 [-2; 4] mmol/l), as compared to the control group (-1 [-3.75; 2]); р < 0.001. This was accompanied by equilibration of the sodium levels between the groups (141.08 ± 4.08 mmol/l in the dapagliflozin group vs 140.05 ± 4.82 mmol/l in the control group; р = 0.096). At the time of discharge, there was no difference in serum sodium concentrations (140.98 ± 4.77 mmol/l vs 139.86 ± 4.45 mmol/l; р = 0.082). The increase in serum sodium concentrations during the period of observation [randomization; discharge] was small but statistically significant in the dapagliflozin group (1 [-3; 3.75] mmol/l vs -2 [-4.5; 2] mmol/l; р = 0.015). Of 36 patients (21 in the dapagliflozin group and 15 in the control group) with baseline hyponatraemia, this persisted in 6 (16.6%) in the dapagliflozin group and in 11 (73.3%) in the control group (р = 0.008). Conclusion The use of dapagliflozin in AHF is associated with a tendency to the increase in serum sodium concentrations and lesser persistence of hyponatremia. This effect occurred within the first 48 hours and persisted until discharge. The impact of dapagliflozin on serum sodium was more pronounced in patients with hyponatremia at randomization.

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Association between serum osmolality and 28-day all-cause mortality in patients with heart failure and reduced ejection fraction: a retrospective cohort study from the MIMIC-IV database

Zou,

Li,

Lin

et al. 2024

Front. Endocrinol.

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BackgroundPrevious studies have not thoroughly explored the impact of serum osmolality levels on early mortality in heart failure and reduced ejection fraction (HFrEF) patients. The purpose of this study was to investigate the relationship between serum osmolality levels and early all-cause mortality in patients with HFrEF.MethodsThe open access MIMIC-IV database was the source of data for our study. We collected demographic data, vital signs, laboratory parameters, and comorbidities of the included patients and divided them into 3 groups based on their initial serum osmolality on admission, with the primary outcome being all-cause mortality within 28 days of admission. Smoothing Spline Fitting Curve, the Kaplan-Meier survival curve, and Threshold effect analysis were used to assess the relationship between serum osmolality and early mortality in HFrEF patients.ResultsA total of 6228 patients (55.31% male) were included. All-cause mortality within 28 days on admission was 18.88% in all patients. After adjusting for confounders, higher serum osmolality levels were independently associated with an increased risk of 28-days all-cause mortality compared with the reference group (Reference group Q2: 290–309 mmol/L, Q4: HR, 1.82 [95% CI 1.19–2.78] P<0.05, Q5: HR, 1.99 [95% CI 1.02–3.91] P<0.05). Smooth spline fitting revealed a U-shaped association between serum osmolality and 28-days all-cause mortality. Further threshold effect analysis results suggested that each unit increase in serum osmolality level was associated with a 2% increase in 28-days all-cause mortality when serum osmolality levels were ≥ 298.8 mmol/L (HR, 1.019 [95% CI 1.012–1.025] P<0.05).ConclusionA U-shaped correlation between initial serum osmolality and 28-days all-cause mortality in HFrEF patients was identified, revealing higher osmolality levels significantly increase mortality risk. These results underscore serum osmolality’s critical role in early mortality among HFrEF patients, highlighting the need for further, larger-scale studies for validation.

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Hyponatraemia in heart failure: time for new solutions?

Cited by 5 publications

References 49 publications

Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in‐hospital and long‐term outcomes – from the ESC‐HFA EORP Heart Failure Long‐Term Registry

Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in‐hospital and long‐term outcomes – from the ESC‐HFA EORP Heart Failure Long‐Term Registry

Impact of Dapagliflozin Treatment on Serum Sodium Concentrations in Acute Heart Failure

Association between serum osmolality and 28-day all-cause mortality in patients with heart failure and reduced ejection fraction: a retrospective cohort study from the MIMIC-IV database

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