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Evaluation and Management of Hyponatremia in Heart Failure

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Abstract

Purpose of Review

To provide a contemporary overview of the pathophysiology, evaluation, and treatment of hyponatremia in heart failure (HF).

Recent Findings

Potassium and magnesium losses due to poor nutritional intake and treatment with diuretics cause an intracellular sodium shift in HF that may contribute to hyponatremia. Impaired renal blood flow leading to a lower glomerular filtration rate and increased proximal tubular reabsorption lead to an impaired tubular flux through diluting distal segments of the nephron, compromising electrolyte-free water excretion.

Summary

Hyponatremia in HF is typically a condition of impaired water excretion by the kidneys on a background of potassium and magnesium depletion. While those cations can and should be easily repleted, further treatment should mainly focus on improving the underlying HF and hemodynamics, while addressing congestion. For decongestive treatment, proximally acting diuretics such as sodium-glucose co-transporter-2 inhibitors, acetazolamide, and loop diuretics are the preferred options.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

AVP:

Arginine vasopressin

ENaCs:

Epithelial sodium channels

HF :

Heart failure

MRA:

Mineralocorticoid receptor antagonists

Na+ :

Sodium

NCC:

Sodium-chloride co-transporter

SGLT2:

Sodium-glucose co-transporter-2

SIADH:

Syndrome of inappropriate anti-diuretic hormone

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Authors and Affiliations

  1. Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy

    Giulio M. Mondellini

  2. Centre for Cardiovascular Diseases, University Hospital Brussels, Laarbeeklaan 101, 1090, Jette, Belgium

    Giulio M. Mondellini & Frederik H. Verbrugge

  3. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium

    Frederik H. Verbrugge

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Correspondence to Frederik H. Verbrugge.

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Mondellini, G.M., Verbrugge, F.H. Evaluation and Management of Hyponatremia in Heart Failure. Curr Heart Fail Rep (2024). https://doi.org/10.1007/s11897-024-00651-3

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