Diuretic needs higher among hyponatraemic ADHF patients

Hyponatraemia during admission for acute decompensated heart failure (ADHF) necessitates higher doses of the diuretic furosemide, reports a recent study.

The study included 103 ADHF patients (median age, 54 years; 81.6 percent male) who had hyponatraemia upon admission. The outcome of interest was the patients’ diuretic requirements. A parallel group of 327 patients (median age, 57 years; 72.2 percent male) who were normonatraemic on admission was also included.

Torsemide was used more frequently in the hyponatraemia group (p=0.043), but prevalence of furosemide and bumetanide was comparable between groups. Baseline furosemide dose was likewise similar between groups, but in-hospital median administrations were significantly greater in those with hyponatraemia (280 vs 200 mg; p<0.001).

Moreover, the increase in dose relative to baseline was also significantly greater in hyponatraemic patients (33 percent vs 0 percent; p=0.007). Discharge doses of furosemide were also higher in patients with hyponatraemia (160 vs 120 mg; p=0.015).

In terms of markers of congestion, patients with hyponatraemia had significantly higher creatinine upon admission (p=0.006) and at day 3 (p=0.007). Direct bilirubin (p=0.044), alanine transaminase (p<0.001) and aspartate transaminase (p=0.002) were all also significantly elevated in the hyponatraemia group upon admission. None of these markers remained heightened over the long term.

“We hope that our findings will encourage hospitalists, emergency physicians, nurse practitioners, nephrologists and physician assistants to provide diuretic doses in ADHF based on volume status without limitations from admission hyponatraemia and/or hypotension,” said the researchers.