Hypertonic Saline in Acute Decompensated Heart Failure (ADHF)

In the USA, hypertonic saline (HS) administration in patients refractory to ADHF (acute decompensated heart failure) appeared to be safe and well-tolerated as an adjuvant to loop diuretics, according to a recent study in the journal JACC: Heart Failure.

According to the study, hypertonic saline administration was associated with increased diuretic efficiency, fluid and weight loss, and improvement of metabolic derangements, and no adverse respiratory or neurological signals were identified.

Hypertonic saline therapy has been described as a potential management strategy for refractory ADHF, but experience in the US is limited. Jeffrey M. Testani, Yale School of Medicine, New Haven, Connecticut, and colleagues investigated the real-world safety and efficacy of hypertonic saline therapy in cases of refractory ADHF at a large U.S. academic medical center.

The researchers performed a retrospective analysis in all the patients receiving hypertonic saline for diuretic therapy-resistant ADHF at the authors' institution since March 2013. The primary analytic approach was a comparison of the trajectory of clinical variables prior to and after administration of hypertonic saline, with secondary focus on predictors of treatment response.

The researchers identified a total of 58 episodes where HS was administered at a single hospital in 40 patients with diuretic-refractory ADHF.

Key Findings of the Study

• Prior to hypertonic saline administration, serum sodium, chloride, and creatinine concentrations were worsening but improved after hypertonic saline administration.
• Both total urine output and weight loss significantly improved with hypertonic saline.
• Diuretic efficiency, defined as change in urine output per doubling of diuretic dose, also improved over this period.
• There were no significant changes in respiratory status or overcorrection of serum sodium with the intervention.

"These findings suggest an additional rigorous study of HS as a diuretic adjuvant for ADHF is warranted," concluded the authors.

The study, "Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center's Experience," is published in the journal JACC: Heart Failure.

DOI: 10.1016/j.jchf.2019.10.012