Hypertonic Saline For The Treatment of Diuretic Resistance In Advanced Heart Failure: A Retrospective Analysis From The Cleveland Clinic

Abstract

Background Recent studies demonstrated that intravenous hypertonic saline solution (HSS) in combination with high-dose furosemide for the management of diuretic resistance in heart failure can lead to improved diuresis, reduction in length of hospitalization and mortality. Objective The objective of this study was to analyze real world use and safety of HSS administration in advanced heart failure patients in the Cleveland Clinic and identify factors for improvement for the development of an institutional protocol. Methods A retrospective chart analysis was performed in all advanced heart failure patients in whom HSS was administer and who were admitted to the intensive heart failure care unit from 2008 to 2019. Results In our study cohort of 34 patients who received HSS (median age 64 [IQR 53,68] years, 56% male, median LVEF 23 [IQR 15,39]%, median Cr 1.4 [IQR 1.1,2.1]mg/dL, median Na 121 [IQR 116,125]mg/dL), all subjects except one received 3% sodium chloride as HSS regimen. There was large variability in amount of NaCl administered (median 5,5 [IQR 3.4,18]g), infusion speed (median 50 [25,71]ml/min) and concurrent intravenous administration of loop diuretics (75%) and their dosages (furosemide median dose 240 [100-490]mg). The change in serum sodium serum sodium (3 [IQR 1, 5] mmol/L) after HSS was significant (p Conclusion Hypertonic saline solution administered has largely restricted to a relatively small cohort of end-stage heart failure patients with significant hyponatremia, and demonstrated increase in serum sodium without detrimental effects on renal function or complications related to sodium repletion or volume overload. However, the lack of a standardized precluded meaningful assessment of safety and efficacy of such interventions.