title: Hypertonic saline solution for prevention of renal dysfunction in patients with decompensated heart failure.
abstract: BACKGROUND
  Renal dysfunction is associated with increased mortality in patients with decompensated heart failure. However, interventions targeted to prevention in this setting have been disappointing. We investigated the effects of hypertonic saline solution (HSS) for prevention of renal dysfunction in decompensated heart failure.
  
  
  METHODS
  In a double-blind randomized trial, patients with decompensated heart failure were assigned to receive three-day course of 100mL HSS (NaCl 7.5%) twice daily or placebo. Primary end point was an increase in serum creatinine of 0.3mg/dL or more. Main secondary end point was change in biomarkers of renal function, including serum levels of creatinine, cystatin C, neutrophil gelatinase-associated lipocalin-NGAL and the urinary excretion of aquaporin 2 (AQP2), urea transporter (UT-A1), and sodium/hydrogen exchanger 3 (NHE3).
  
  
  RESULTS
  Twenty-two patients were assigned to HSS and 12 to placebo. Primary end point occurred in two (10%) patients in HSS group and six (50%) in placebo group (relative risk 0.3; 95% CI 0.09-0.98; P=0.01). Relative to baseline, serum creatinine and cystatin C levels were lower in HSS as compared to placebo (P=0.004 and 0.03, respectively). NGAL level was not statistically different between groups, however the urinary expression of AQP2, UT-A1 and NHE3 was significantly higher in HSS than in placebo.
  
  
  CONCLUSIONS
  HSS administration attenuated heart failure-induced kidney dysfunction as indicated by improvement in both glomerular and tubular defects, a finding with important clinical implications. HSS modulated the expression of tubular proteins involved in regulation of water and electrolyte homeostasis.
authors.affiliation: Heart Institute, InCor, do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. victor.issa@incor.usp.br
authors.forename: Victor S
authors.initials: VS
authors.lastname: Issa
authors.forename: Lucia
authors.initials: L
authors.lastname: Andrade
authors.forename: Silvia M
authors.initials: SM
authors.lastname: Ayub-Ferreira
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: Ana C
authors.initials: AC
authors.lastname: de Bragança
authors.forename: Guilherme V
authors.initials: GV
authors.lastname: Guimarães
authors.forename: Fabiana G
authors.initials: FG
authors.lastname: Marcondes-Braga
authors.forename: Fátima D
authors.initials: FD
authors.lastname: Cruz
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Chizzola
authors.forename: Germano E
authors.initials: GE
authors.lastname: Conceição-Souza
authors.forename: Irineu T
authors.initials: IT
authors.lastname: Velasco
authors.forename: Edimar A
authors.initials: EA
authors.lastname: Bocchi
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*
chemical_list: D012462:Saline Solution, Hypertonic