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Hypertonic saline plus i.v. furosemide improve renal safety profile and clinical outcomes in acute decompensated heart failure

A meta-analysis of the literature

Besseres renales Sicherheitsprofil und klinische Ergebnisse durch hypertone Kochsalzlösung plus Furosemid i.v. bei akuter dekompensierter Herzinsuffizienz

Eine Metaanalyse der Literatur

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Abstract

Background

In advanced congestive heart failure (CHF), intravenous (i.v.) inotropic agents, i.v. diuretics, ultrafiltration, and hemodialysis have been shown to not yield better clinical outcomes. In this scenario, the simultaneous administration of hypertonic saline solution (HSS) and furosemide may offer a more effective therapeutic option with a good safety profile.

Methods

Therefore, a meta-analysis was performed to compare combined therapy, consisting of i.v. furosemide plus concomitant administration of HSS, with i.v. furosemide alone for acute decompensated heart failure (ADHF). The outcomes we chose were all-cause mortality, risk of re-hospitalization for ADHF, length of hospital stay, weight loss, and variation of serum creatinine.

Results

Based on five randomized controlled trials (RCTs) involving 1,032 patients treated with i.v. HSS plus furosemide vs. 1,032 patients treated with i.v. furosemide alone, a decrease in all-cause mortality in patients treated with HSS plus furosemide was proven [RR = 0.57; 95 % confidence interval (CI) = 0.44–0.74, p = 0.0003]. Likewise, combined therapy with HSS plus furosemide was shown to be associated with a reduced risk of ADHF-related re-hospitalization (RR = 0.51; 95 % CI = 0.35–0.75, p = 0.001). Besides, combined therapy with HSS plus furosemide was found to be associated with a reduced length of hospital stay (p = 0.0002), greater weight loss (p < 0.00001), and better preservation of renal function (p < 0.00001).

Conclusion

HSS as an adjunct to i.v. furosemide for diuretic-resistant CHF patients led to a better renal safety profile and improved clinical endpoints such as mortality and heart failure-related hospitalizations.

Zusammenfassung

Hintergrund

Bei fortgeschrittener kongestiver Herzinsuffizienz (CHF) haben intravenös (i.v.) applizierte inotrope Substanzen, i.v.-Diuretika, Ultrafiltration und Hämodialyse nachgewiesenermaßen nicht zu besseren klinischen Ergebnissen geführt. Im vorliegenden Szenario stellen die gleichzeitige Gabe von hypertoner Kochsalzlösung (HSS) und Furosemid möglicherweise eine wirksamere therapeutische Option mit gutem Sicherheitsprofil dar.

Methoden

Daher wurde eine Metaanalyse durchgeführt mit dem Ziel, die kombinierte Therapie aus Furosemid i.v. plus begleitender Gabe von HSS mit der Gabe von Furosemid i.v. allein bei akut dekompensierter Herzinsuffizienz (ADHF) zu vergleichen. Die gewählten Endpunkte waren Mortalität aus sämtlichen Ursachen, Risiko der Wiederaufnahme ins Krankenhaus wegen ADHF, Krankenhausverweildauer, Gewichtsabnahme und Veränderung des Serumkreatinins.

Ergebnisse

Auf der Grundlage von 5 randomisierten kontrollierten Studien mit 1032 Patienten, die mit HSS plus Furosemid i.v. behandelt wurden, versus 1032 Patienten, die mit Furosemid i.v. allein behandelt wurden, wurde eine Abnahme der Mortalität aus sämtlichen Ursachen bei Patienten mit der Gabe von HSS plus Furosemid nachgewiesen (RR = 0,57; 95%-Konfidenzintervall, 95%-KI: 0,44–0,74; p = 0,0003). Gleichermaßen wurde gezeigt, dass die kombinierte Therapie aus HSS plus Furosemid mit einem verminderten Risiko einer stationären Wiederaufnahme wegen ADHF einherging (RR = 0,51; 95%-KI: 0,35–0,75; p = 0,001). Außerdem stellte sich heraus, dass die kombinierte Therapie aus HSS plus Furosemid mit einer geringeren Krankenhausverweildauer (p = 0,0002), größerer Gewichtsabnahme (p < 0,00001) und besserer Aufrechterhaltung der Nierenfunktion (p < 0,00001) assoziiert war.

Schlussfolgerung

Mit HSS zusätzlich zu Furosemid bei diuretikaresistenten CHF-Patienten wurde eine Verbesserung des renalen Sicherheitsprofils und klinischer Endpunkte wie Mortalität und herzinsuffizienzbedingte stationäre Aufnahme wahrscheinlich.

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Compliance with ethical guidelines

Conflict of interest. R. De Vecchis, C. Esposito, C. Ariano, and S. Cantatrione declare that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, Naples, Italy

    R. De Vecchis MD, C. Ariano & S. Cantatrione

  2. Institute of Hygiene and Preventive Medicine, Second University of Naples, Naples, Italy

    C. Esposito

Authors
  1. R. De Vecchis MD
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  2. C. Esposito
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  3. C. Ariano
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  4. S. Cantatrione
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Correspondence to R. De Vecchis MD.

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Additional material onlineThis article includes additional material online. You will find this supplemental at dx.doi.org/10.1007/s00059-013-4041-6.

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De Vecchis, R., Esposito, C., Ariano, C. et al. Hypertonic saline plus i.v. furosemide improve renal safety profile and clinical outcomes in acute decompensated heart failure. Herz 40, 423–435 (2015). https://doi.org/10.1007/s00059-013-4041-6

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