Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center's Experience.
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.
['Griffin|Matthew|M|', 'Soufer|Aaron|A|', 'Goljo|Erden|E|', 'Colna|Matthew|M|', 'Rao|Veena S|VS|', 'Jeon|Sangchoon|S|', 'Raghavendra|Parinita|P|', "D'Ambrosi|Julie|J|", 'Riello|Ralph|R|', 'Coca|Steven G|SG|', 'Mahoney|Devin|D|', 'Jacoby|Daniel|D|', 'Ahmad|Tariq|T|', 'Chen|Michael|M|', 'Tang|W H Wilson|WHW|', 'Turner|Jeffrey|J|', 'Mullens|Wilfried|W|', 'Wilson|Francis P|FP|', 'Testani|Jeffrey M|JM|']
D000208:Acute Disease D004232:Diuretics D004305:Dose-Response Relationship, Drug D005260:Female D005500:Follow-Up Studies D005665:Furosemide D006333:Heart Failure D006801:Humans D007262:Infusions, Intravenous D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012462:Saline Solution, Hypertonic D013318:Stroke Volume D016896:Treatment Outcome D014481:United States
cardiorenal diuretic resistance sodium regulation