Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure.
BACKGROUND
Theoretically, salt supplementation should promote diuresis through increasing the glomerular filtration rate (GFR) during treatment of acute decompensated heart failure (ADHF) even with low-dose furosemide; however, there is little evidence to support this idea.


METHODS AND RESULTS
This was a prospective, randomized, open-label, controlled trial that compared the diuretic effectiveness of salt infusion with that of glucose infusion supplemented with low-dose furosemide in 44 consecutive patients with ADHF. Patients were randomly administered 1.7% hypertonic saline solution supplemented with 40 mg furosemide (salt infusion group) or glucose supplemented with 40 mg furosemide (glucose infusion group). Our major end points were 24-hour urinary volume and GFR. Urinary volume was greater in the salt infusion group than in the glucose infusion group (2,701 ± 920 vs 1,777 ± 797 mL; P < .001). There was no significant difference in the estimated GFR at baseline. Creatinine clearance for 24 h was greater in the salt infusion group than in the glucose infusion group (63.5 ± 52.6 vs 39.0 ± 26.3 mL min(-1) 1.73 m(-2); P = .048).


CONCLUSIONS
Salt supplementation rather than salt restriction evoked favorable diuresis through increasing GFR. The findings support an efficacious novel approach of the treatment of ADHF.
['Okuhara|Yoshitaka|Y|', 'Hirotani|Shinichi|S|', 'Naito|Yoshiro|Y|', 'Nakabo|Ayumi|A|', 'Iwasaku|Toshihiro|T|', 'Eguchi|Akiyo|A|', 'Morisawa|Daisuke|D|', 'Ando|Tomotaka|T|', 'Sawada|Hisashi|H|', 'Manabe|Eri|E|', 'Masuyama|Tohru|T|']
D000208:Acute Disease D000368:Aged D000369:Aged, 80 and over D004359:Drug Therapy, Combination D005260:Female D005665:Furosemide D005919:Glomerular Filtration Rate D005947:Glucose D006333:Heart Failure D006801:Humans D007262:Infusions, Intravenous D008297:Male D008875:Middle Aged D011446:Prospective Studies D012462:Saline Solution, Hypertonic D012965:Sodium Chloride D016896:Treatment Outcome
heart failure glomerular filtration rate Salt restriction loop diuretics