Hypertonic saline solution for renal failure prevention in patients with decompensated heart failure.
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.
Issa
Victor Sarli
VS
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. victorissa@cardiol.br
Bacal
Fernando
F
Mangini
Sandrigo
S
Carneiro
Rodrigo Moreno Dias
RM
Azevedo
Cristiano Humberto Naves de Freitas
CH
Chizzola
Paulo Roberto
PR
Ferreira
Silvia Moreira Ayub
SM
Bocchi
Edimar Alcides
EA
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
D015415:Biomarkers; D002316:Cardiotonic Agents; D004232:Diuretics; D012462:Saline Solution, Hypertonic; D004280:Dobutamine; D005665:Furosemide; D014508:Urea; D012964:Sodium; D003404:Creatinine; D011188:Potassium