title: Hypertonic saline solution for renal failure prevention in patients with decompensated heart failure.
abstract: BACKGROUND
  Hyponatremia and congestive phenomena indicate a bad prognosis in decompensated heart failure. The occurrence of renal failure is associated to an increased death risk.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of the hypertonic saline solution in patients with decompensated heart failure for renal failure prevention.
  
  
  METHODS
  Patients with decompensated heart failure, congestion and hyponatremia participated in the study. In addition to the standard treatment, the patients received hypertonic saline solution and were submitted to clinical as well as laboratory assessment.
  
  
  RESULTS
  Nine patients were enrolled in the study. Mean age was 55 + 14.2 years, being 5 male (55.5%) and 4 (44.5%) female patients. All of them presented functional class III-IV of the New York Heart Association (NYHA), and 5 (55.5%) received dobutamine. All of them presented initial creatinine > 1.4 mg/dl. The mean tonicity of the solution was 4.39% + 0.018% (2.5% to 7.5%) and the duration of treatment was 4.9 days + 4.1 days (1-15 days). There were no severe adverse effects; none of the patients presented clinical worsening or neurologic disorders; hypokalemia occurred in 4 cases (44.5%). The comparison of the variables before and after treatment showed a decrease in urea (105 mg/dl + 74.8 mg/dl vs. 88 mg/dl + 79.4 mg/dl; p = 0.03) and increase in the urinary volume (1,183 ml/day vs. 1,778 ml/day; p = 0.03); there was no tendency to creatinine decrease (2.0 mg/dl + 0.8 mg/dl vs. 1.7 mg/dl + 1.0 mg/dl; p = 0.08). Despite the elevation in sodium levels (131 mEq/l + 2.8 mEq/l vs. 134 mEq/l + 4.9 mEq/l) and weight decrease (69.5 kg + 18.6 kg vs. 68.2 kg + 17.1 kg), there was no statistically significant difference.
  
  
  CONCLUSIONS
  The use of hypertonic saline solution in patients with decompensated heart failure can be a safe therapeutic method and potentially related to clinical improvement and renal failure prevention.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. victorissa@cardiol.br
authors.forename: Victor Sarli
authors.initials: VS
authors.lastname: Issa
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: Sandrigo
authors.initials: S
authors.lastname: Mangini
authors.forename: Rodrigo Moreno Dias
authors.initials: RM
authors.lastname: Carneiro
authors.forename: Cristiano Humberto Naves de Freitas
authors.initials: CH
authors.lastname: Azevedo
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Chizzola
authors.forename: Silvia Moreira Ayub
authors.initials: SM
authors.lastname: Ferreira
authors.forename: Edimar Alcides
authors.initials: EA
authors.lastname: Bocchi
mesh_terms: D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007008:Hypokalemia / Q000209:etiology; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D051437:Renal Insufficiency / Q000517:prevention & control*; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D004232:Diuretics; D012462:Saline Solution, Hypertonic; D004280:Dobutamine; D005665:Furosemide; D014508:Urea; D012964:Sodium; D003404:Creatinine; D011188:Potassium