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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 Hirotani
Original Article
  • 173 Downloads

Abstract

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.

Keywords

Acute decompensated heart failure Loop diuretics Hypertonic saline Diuretic efficiency 

Notes

Acknowledgements

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

Compliance with ethical standards

Funding

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.

References

  1. 1.
    Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149:209–216CrossRefPubMedGoogle Scholar
  2. 2.
    Gheorghiade M, Filippatos G, De Luca L, Burnett J (2006) Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med 119:S3–S10CrossRefPubMedGoogle Scholar
  3. 3.
    Felker GM, Mentz RJ (2012) Diuretics and ultrafiltration in acute decompensated heart failure. J Am Coll Cardiol 59:2145–2153CrossRefPubMedGoogle Scholar
  4. 4.
    Neuberg GW, Miller AB, O’Connor CM, Belkin RN, Carson PE, Cropp AB, Frid DJ, Nye RG, Pressler ML, Wertheimer JH, Packer M (2002) Diuretic resistance predicts mortality in patients with advanced heart failure. Am Heart J 144:31–38CrossRefPubMedGoogle Scholar
  5. 5.
    Eshaghian S, Horwich TB, Fonarow GC (2006) Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol 97:1759–1764CrossRefPubMedGoogle Scholar
  6. 6.
    Testani JM, Brisco MA, Turner JM, Spatz ES, Bellumkonda L, Parikh CR, Tang WH (2014) Loop diuretic efficiency: a metric of diuretic responsiveness with prognostic importance in acute decompensated heart failure. Circ Heart Fail 7:261–270CrossRefPubMedGoogle Scholar
  7. 7.
    Okuhara Y, Hirotani S, Naito Y, Nakabo A, Iwasaku T, Eguchi A, Morisawa D, Ando T, Sawada H, Manabe E, Masuyama T (2014) Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure. J Card Fail 20:295–301CrossRefPubMedGoogle Scholar
  8. 8.
    Licata G, Di Pasquale P, Parrinello G, Cardinale A, Scandurra A, Follone G, Argano C, Tuttolomondo A, Paterna S (2003) Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: long-term effects. Am Heart J 145:459–466CrossRefPubMedGoogle Scholar
  9. 9.
    Paterna S, Fasullo S, Parrinello G, Cannizzaro S, Basile I, Vitrano G, Terrazzino G, Maringhini G, Ganci F, Scalzo S, Sarullo FM, Cice G, Di Pasquale P (2011) Short-term effects of hypertonic saline solution in acute heart failure and long-term effects of a moderate sodium restriction in patients with compensated heart failure with New York Heart Association class III (Class C) (SMAC-HF Study). Am J Med Sci 342(1):27–37CrossRefPubMedGoogle Scholar
  10. 10.
    Issa VS, Bacal F, Mangini S, Carneiro RM, Azevedo CH, Chizzola PR, Ferreira SM, Bocchi EA (2007) Hypertonic saline solution for renal failure prevention in patients with decompensated heart failure. Arq Bras Cardiol 89:251–255CrossRefPubMedGoogle Scholar
  11. 11.
    Imai E, Horio M, Nitta K, Yamagata K, Iseki K, Tsukamoto Y, Ito S, Makino H, Hishida A, Matsuo S (2007) Modification of the modification of diet in renal disease (MDRD) study equation for Japan. Am J Kidney Dis 50:927–937CrossRefPubMedGoogle Scholar
  12. 12.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270CrossRefPubMedGoogle Scholar
  13. 13.
    Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458CrossRefPubMedGoogle Scholar
  14. 14.
    Okuhara Y, Hirotani S, Ando T, Nishimura K, Orihara Y, Komamura K, Naito Y, Mano T, Masuyama T (2017) Comparison of salt with low-dose furosemide and carperitide for treating acute decompensated heart failure: a single-center retrospective cohort study. Heart Vessels 32(4):419–427CrossRefPubMedGoogle Scholar
  15. 15.
    Schrier RW, Fassett RG (1998) Pathogenesis of sodium and water retention in cardiac failure. Ren Fail 20:773–781CrossRefPubMedGoogle Scholar
  16. 16.
    Schrier RW (2006) Water and sodium retention in edematous disorders: role of vasopressin and aldosterone. Am J Med 119:S47–S53CrossRefPubMedGoogle Scholar
  17. 17.
    Volpe M, Magri P, Rao MA, Cangianiello S, DeNicola L, Mele AF, Memoli B, Enea I, Rubattu S, Gigante B, Trimarco B, Epstein M, Condorelli M (1997) Intrarenal determinants of sodium retention in mild heart failure: effects of angiotensin-converting enzyme inhibition. Hypertension 30:168–176CrossRefPubMedGoogle Scholar
  18. 18.
    Singh D, Shrestha K, Testani JM, Verbrugge FH, Dupont M, Mullens W, Tang WH (2014) Insufficient natriuretic response to continuous intravenous furosemide is associated with poor long-term outcomes in acute decompensated heart failure. J Card Fail 20:392–399CrossRefPubMedPubMedCentralGoogle Scholar

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
  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan

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