Heart and Vessels

, Volume 33, Issue 9, pp 1029–1036 | Cite as

Urinary composition predicts diuretic efficiency of hypertonic saline solution with furosemide therapy and heart failure prognosis

  • Tomotaka Ando
  • Yoshitaka Okuhara
  • Yoshiyuki Orihara
  • Koichi Nishimura
  • Kyoko Yamamoto
  • Tohru Masuyama
  • Shinichi HirotaniEmail author
Original Article


Recently, we and other group have reported that furosemide administration along with hypertonic saline solution enhanced diuretic efficiency of furosemide. However, little is known about factors which associated with high diuretic efficiency by hypertonic saline solution with furosemide therapy. To identify predictors of diuretic efficiency in the hypertonic saline solution with furosemide therapy, we recruited 30 consecutive hospitalized heart failure (HF) patients with volume overload (77 ± 10 years, systolic blood pressure > 90 mmHg, and estimated glomerular filtration rate > 15 ml/min/1.73 m2). Hypertonic saline with furosemide solution, consisting of 500 ml of 1.7% hypertonic saline solution with 40 mg of furosemide, was administered continuously over 24 h. The patients were divided into two groups on the basis of 24-h urine volume (UV) after initiation of diuretic treatment ≥ 2000 ml (high urine volume: HUV) and < 2000 ml (low urine volume: LUV). The basal clinical characteristics of both groups were analyzed and the predictors of HUV after receiving the treatment were identified. There were not significant differences between two groups in baseline clinical characteristics and medication. Univariate logistic analysis revealed that blood urea nitrogen/creatinine ratio, urine urea nitrogen/creatinine ratio (UUN/UCre), fractional excretion of sodium, and tricuspid annular plane systolic excursion positively associated with HUV. Multivariate logistic regression analysis revealed that UUN/UCre at baseline was independently associated with HUV, and UUN/UCre best predicts HUV by the therapy with a cut-off value of 6.16 g/dl/g Cre (AUC 0.910, 95% CI 0.696–0.999, sensitivity 80%, specificity 87%). The Kaplan–Meier curves revealed significant difference for HF rehospitalization and death rate at 180 days between patients with UUN/UCre ≥ 6.16 g/dl/g Cre and those with UUN/UCre < 6.16 g/dl/g Cre (log-rank P = 0.0489). UUN/UCre at baseline strongly predicted of diuretic efficiency in the hypertonic saline solution with furosemide therapy, and was associated with HF prognosis.


Acute decompensated heart failure Loop diuretics Hypertonic saline Diuretic efficiency 



We sincerely thank all of the patients, collaborating physicians, and other medical staff for their important contributions to this study.

Compliance with ethical standards


This study is supported by researcher’s grant from Hyogo College of Medicine for Shinichi Hirotani.

Conflict of interest

There is no conflict of interest with any financial organization.


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Tomotaka Ando
    • 1
  • Yoshitaka Okuhara
    • 1
  • Yoshiyuki Orihara
    • 1
  • Koichi Nishimura
    • 1
  • Kyoko Yamamoto
    • 1
  • Tohru Masuyama
    • 1
  • Shinichi Hirotani
    • 1
    Email author
  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan

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