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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Effects of hypertonic saline solution on body weight and serum creatinine in patients with acute decompensated heart failure
Gabrielle Lafrenière, Patrick Béliveau, Jean-Yves Bégin, David Simonyan, Sylvain Côté, Valérie Gaudreault, Zeev Israeli, Shahar Lavi, Rodrigo Bagur
Gabrielle Lafrenière, Patrick Béliveau, Valérie Gaudreault, Division of Cardiology, Department of Medicine, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC G1R 2J6, Canada
Jean-Yves Bégin, Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC G9A 5H7, Canada
David Simonyan, Clinical Research Platform, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC G1R 2J6, Canada
Sylvain Côté, Department of Pharmacy, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC G1R 2J6, Canada
Zeev Israeli, Shahar Lavi, Rodrigo Bagur, Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, ON N6A5A5, Canada
Author contributions: Lafrenière G and Béliveau P contributed equally to this work; they participated with the conception and design, acquisition, analysis and interpretation of data and drafting of the manuscript; Bégin JY and Simonyan D created the database and performed analysis and interpretation of data and reviewed critically the manuscript for important intellectual content; Côté S participated with the elaboration of the drug therapy protocol, and reviewed critically the manuscript for important intellectual content; Israeli Z and Lavi S participated in the analysis and interpretation of data, and revising critically the manuscript for important intellectual content; Gaudreault V participated in patient recruitment of patients and revising critically the manuscript for important intellectual content; Bagur R participated in the acquisition, analysis and interpretation of data, and drafting of the manuscript; all authors have read and approved the final version of the manuscript.
Institutional review board statement: Not applicable.
Informed consent statement: Informed consent was not required because of the retrospective nature of this study.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rodrigo Bagur, MD, PhD, FAHA, Assistant Clinical Academic Professor, Division of Cardiology, London Health Sciences Centre, Department of Medicine, Western University, 339 Windermere Rd, University Hospital, London, ON N6A5A5, Canada.
rodrigobagur@yahoo.com
Telephone: +1-519-6633997 Fax: +1-519-4343278
Received: December 18, 2016
Peer-review started: December 19, 2016
First decision: January 28, 2017
Revised: May 25, 2017
Accepted: June 6, 2017
Article in press: June 8, 2017
Published online: August 26, 2017
Processing time: 249 Days and 4.6 Hours
AIM
To test the safety and effectiveness of hypertonic saline solution (HSS + F) as a strategy for weight loss and prevention of further deterioration of renal function.
METHODS
Patients admitted with acute decompensated heart failure (ADHF) who received HSS + F were included in the study. After a period of a standard ADHF treatment, our patients received an intravenous infusion of furosemide (250 mg) combined with HSS (150 mL of 3% NaCl) twice a day for a mean duration of 2.3 d. Our primary outcomes were weight loss and a change in serum creatinine per day of treatment. The parameters of the period prior to treatment with HSS + F were compared with those of the period with HSS + F.
RESULTS
A total of 47 patients were included. The mean creatinine on admission was 155 μmol/L ± 65 μmol/L, the ejection fraction was 40% ± 17%. The experimental treatment (HSS + F) resulted in greater weight loss per day of treatment than the standard treatment (-1.4 kg/d ± 1.4 kg/d vs -0.4 kg/d ± 1.0 kg/d, P = 0.0168). Importantly, the change in creatinine was not significantly different.
CONCLUSION
This study supports the effectiveness of HSS + F on weight loss in patients with ADHF. The safety profile, particularly with regard to renal function, leads us to believe that HSS + F may be a valuable option for those patients presenting with ADHF who do not respond to conventional treatment with intravenous furosemide alone.
Core tip: Hypertonic saline solution (HSS) has been proposed in recent years as a potential therapy to facilitate diuresis in patients with decompensated heart failure and to overcome diuretic resistance. This study supports the effectiveness of HSS + F on weight loss in patients with acute decompensated heart failure and a high burden of comorbidities, despite a proportion of patients having preserved ejection fraction, right heart failure and advanced renal failure. The administration of small intravenous boluses of HSS in conjunction with intravenous furosemide can be a feasible and inexpensive therapeutic option which can prevent the use of costlier and more invasive treatments such as ultrafiltration, hemodialysis and inotropic infusion.
