Intravenous sodium chloride supplementation during decongestion in acute heart failure increased net diuresis to 1980 mL compared to 1010 mL without fluids (p<0.001).
Does intravenous fluid and sodium chloride supplementation improve urine volume and natriuresis in patients with acute heart failure undergoing decongestion?
Intravenous fluid replacement, particularly with sodium chloride supplementation, during decongestion in acute heart failure paradoxically augments diuresis and natriuresis compared to standard fluid restriction.
Absolute Event Rate: 0% vs 0%
Abstract Background For many years, fluid and sodium restriction have been considered an essential strategy for achieving effective decongestion in acute heart failure (AHF), but this paradigm has recently been questioned. This analysis aims to evaluate and compare the effectiveness of three different fluid strategies for decongestion: no fluid, fluid with sodium/chloride, and fluid without sodium/chloride in AHF. Methods and results This post-hoc analysis of two prospective, single-center, mechanistic studies included 55 patients with AHF and fluid overload. All patients received standardized furosemide dosing. A total of 21 patients received a continuous infusion of 0.9% NaCl (83 mL/h), 19 patients received 5% glucose (83 mL/h), and 15 did not receive any fluids. The primary outcome is urine volume and natriuresis at 6 hours after loop diuretic administration. There was a significant difference in cumulative (6 hours) net natriuresis between patients receiving fluid therapy (n=40) and those without fluid therapy (n=15) (139 66-264 mmol vs. 79 15-144mmol, p=0.043). There was no significant difference in cumulative net diuresis between these groups (1170 880-1890mL vs. 1010 475-1270mL, p = 0.078), respectively. The NaCl group had a better diuretic response when compared to the glucose and no fluids groups (absolute: 1980 1620-3150mL vs. 1510 1075-2175mL vs. 1010 475-1270mL, p0.001, net: 1480 1120-2650mL vs. 1010 575-1675mL vs. 1010 475-1270mL, p=0.019, respectively) but the difference in natriuresis did not meet statistical significance (p=0.126). Conclusions Intravenous fluid replacement during decongestion in patients with AHF was associated with increased net natriuresis and a trend toward higher urine output, with a significant augmentation of diuresis with sodium chloride supplementation.
Iwanek et al. (Tue,) reported a other. Intravenous sodium chloride supplementation during decongestion in acute heart failure increased net diuresis to 1980 mL compared to 1010 mL without fluids (p<0.001).