Intravenous Salt Supplementation With Low-Dose Furosemide for Treatment of Acute Decompensated Heart Failure

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• 作者：Yoshitaka Okuhara ; MD ; Shinichi Hirotani ; MD ; PhD ; ^{hirotani@hyo-med.ac.jp" class="auth_mail} ; Yoshiro Naito ; MD ; PhD ; Ayumi Nakabo ; MD ; Toshihiro Iwasaku ; MD ; Akiyo Eguchi ; MD ; Daisuke Morisawa ; MD ; Tomotaka Ando ; MD ; Hisashi Sawada ; MD ; Eri Manabe ; MD ; Tohru Masuyama ; MD ; PhD
• 关键词：Salt restriction ; heart failure ; glomerular filtration rate ; loop diuretics
• 刊名：Journal of Cardiac Failure
• 出版年：May 2014
• 年：2014
• 卷：20
• 期：5
• 页码：295-301
• 全文大小：416 K

文摘

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.

Methods and 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.