title: Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure: a double-blind study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of a new treatment for refractory congestive heart failure (CHF) on brain natriuretic peptide (BNP) plasma levels and hydration station.
  
  
  BACKGROUND
  The study was aimed at evaluating the effects of the combination of high-dose furosemide and small-volume hypertonic saline solution (HSS) in refractory CHF patients.
  
  
  METHODS
  A total of 94 patients (34 women/60 men) with refractory CHF (age 55 to 80 years) were enrolled. They had to have an ejection fraction <35%, serum creatinine <2 mg/dl, blood urea nitrogen <60 mg/dl, a reduced urinary volume, and a low natriuresis (<500 ml/24 h and <60 mEq/24 h, respectively). Patients were divided (double-blind) into two groups: group 1 (18 women/30 men) received an intravenous furosemide (500 to 1,000 mg) plus HSS twice a day in 30 min. Group 2 (16 women/30 men) received an intravenous bolus of furosemide (500 to 1,000 mg/twice a day) alone, for four to six days. At entry, body weight, blood pressure, heart rate, and laboratory parameters were checked during hospitalization; BNP levels were measured on admission, 6 and 30 days after discharge, while on admission and 6 days after, impedance plethysmography was performed. The HSS group received 120 mmol of Na intake versus 80 mmol in non-HSS group. Fluid intake of 1,000 was given to both groups.
  
  
  RESULTS
  The groups were similar for clinical characteristics. A significant increase in daily diuresis and natriuresis was observed in HSS group, p < 0.05. The BNP values showed significant intragroup and intergroup differences, 6 and 30 days after treatment. The patients from the HSS group reached a better hydration state than the non-HSS group after six days. In addition, the HSS group showed a significant reduction in hospitalization time and readmission rate.
  
  
  CONCLUSIONS
  Our data show that the HSS group reached dry weight more rapidly, a significantly faster reduction in BNP levels, shorter hospitalization stay, and lower incidence in readmissions in the 30-day study period.
authors.affiliation: Department of Emergency Medicine, University of Palermo, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paterna
authors.forename: Pietro
authors.initials: P
authors.lastname: Di Pasquale
authors.forename: Gaspare
authors.initials: G
authors.lastname: Parrinello
authors.forename: Ersilia
authors.initials: E
authors.lastname: Fornaciari
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Gaudio
authors.forename: Sergio
authors.initials: S
authors.lastname: Fasullo
authors.forename: Marco
authors.initials: M
authors.lastname: Giammanco
authors.forename: Filippo M
authors.initials: FM
authors.lastname: Sarullo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Licata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D004232:Diuretics; D012462:Saline Solution, Hypertonic; D020097:Natriuretic Peptide, Brain; D005665:Furosemide