Key result
Supplemental sodium with furosemide significantly decreased serum creatinine (MD -0.33 mg/dL; 95% CI -0.50 to -0.17) and length of hospital stay compared to furosemide alone in ADHF.
Why the study?
Standard inpatient management of ADHF has included restricted dietary sodium, but sodium supplementation with diuretics has been proposed as an alternative.
Does prescribed oral and/or intravenous sodium supplementation with furosemide improve clinical and intermediate outcomes in patients hospitalized for acute decompensated heart failure?
Systematic Review
Does prescribed oral and/or intravenous sodium supplementation with furosemide improve clinical and intermediate outcomes in patients hospitalized for acute decompensated heart failure?
Mean Difference: -0.33 (95% CI -0.5–-0.17)
In patients hospitalized for acute decompensated heart failure, sodium supplementation combined with furosemide may improve kidney function, promote weight loss, and reduce length of hospital stay compared to furosemide alone.
May support sodium supplementation with loop diuretics over restriction in ADHF; challenges guidelines and extends RCT evidence on renal function and diuresis.
BACKGROUND: Standard inpatient management of acute decompensated heart failure (ADHF) has included restricted dietary sodium. Sodium supplementation with diuretics has been proposed as an alternative to treat ADHF in an inpatient setting. OBJECTIVES: We conducted a systematic review to evaluate prescribed oral and/or intravenous sodium supplementation (with diuretics), to patients hospitalized for ADHF. METHODS: We searched Medline, Embase, ClinicalTrials.gov, CINAHL, and Cochrane Database of Systematic Reviews from inception to September 24, 2024, for randomized controlled trials (RCTs), and nonrandomized comparative studies (NRCSs) reporting intermediate, clinical, or health service use outcomes for ADHF inpatients. We assessed risk of bias, and where there were at least three studies reporting results from similar analyses, we conducted meta-analyses. GRADE methodology was used to assess the strength of evidence. RESULTS: Fourteen RCTs and two NRCSs compared supplemental sodium with furosemide to furosemide alone. Supplemental sodium with furosemide significantly decreased serum creatinine (pooled net mean difference [NMD]: -0.33 mg/dL, 95% confidence interval [CI]: [-0.50 to -0.17]), brain natriuretic peptide (pooled NMD: -62.84 pg/mL, 95% CI: [-103.61 to -22.08]), and weight (pooled NMD: -2.48 kg, 95% CI: [-4.31 to -0.66]). There were no significant differences in N-terminal pro b-type natriuretic peptide (pooled NMD: -1614 pg/mL, 95% CI: [-3582 to 353]). There was a significant decrease in length of hospital stay (pooled MD: -2.68 days, 95% CI: [-3.81 to -1.55]). Studies provided insufficient evidence on mortality and readmission outcomes, and no evidence for caloric intake or clinical congestion score. CONCLUSIONS: Sodium supplementation with diuretics may improve kidney function, promote weight loss, and shorten length of hospital stay.
No takes yet. Share an insight, caveat, or question.
Ja et al. (2025) conducted a systematic review in acute decompensated heart failure (ADHF). Supplemental sodium with furosemide vs. furosemide alone was evaluated on serum creatinine (NMD -0.33, 95% CI -0.50 to -0.17). Supplemental sodium with furosemide significantly decreased serum creatinine (MD -0.33 mg/dL; 95% CI -0.50 to -0.17) and length of hospital stay compared to furosemide alone in ADHF.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: