Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure.
BACKGROUND
Theoretically, salt supplementation should promote diuresis through increasing the glomerular filtration rate (GFR) during treatment of acute decompensated heart failure (ADHF) even with low-dose furosemide; however, there is little evidence to support this idea.


RESULTS
This was a prospective, randomized, open-label, controlled trial that compared the diuretic effectiveness of salt infusion with that of glucose infusion supplemented with low-dose furosemide in 44 consecutive patients with ADHF. Patients were randomly administered 1.7% hypertonic saline solution supplemented with 40 mg furosemide (salt infusion group) or glucose supplemented with 40 mg furosemide (glucose infusion group). Our major end points were 24-hour urinary volume and GFR. Urinary volume was greater in the salt infusion group than in the glucose infusion group (2,701 ± 920 vs 1,777 ± 797 mL; P < .001). There was no significant difference in the estimated GFR at baseline. Creatinine clearance for 24 h was greater in the salt infusion group than in the glucose infusion group (63.5 ± 52.6 vs 39.0 ± 26.3 mL min(-1) 1.73 m(-2); P = .048).


CONCLUSIONS
Salt supplementation rather than salt restriction evoked favorable diuresis through increasing GFR. The findings support an efficacious novel approach of the treatment of ADHF.
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Yoshitaka
Y
Okuhara
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan. Electronic address: hirotani@hyo-med.ac.jp.
Shinichi
S
Hirotani
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Yoshiro
Y
Naito
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Ayumi
A
Nakabo
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Toshihiro
T
Iwasaku
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Akiyo
A
Eguchi
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Daisuke
D
Morisawa
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Tomotaka
T
Ando
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Hisashi
H
Sawada
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Eri
E
Manabe
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Tohru
T
Masuyama
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D005947:Glucose / Q000008:administration & dosage; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome
D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; D005665:Furosemide; D005947:Glucose
Salt restriction; glomerular filtration rate; heart failure; loop diuretics