Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA.
Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Heart Lung Circ. 2020 Feb;29(2):233-241. doi: 10.1016/j.hlc.2018.12.014. Epub 2019 Jan 28.
Diuretic requirements in patients with acute decompensated heart failure (ADHF) and hyponatraemia versus normonatraemia on admission has not been previously explored.
The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial dataset was utilised to examine the characteristics and diuretic requirements of patients with ADHF with hyponatraemia or normonatraemia on admission.
Patients with ADHF and admission hyponatraemia (n = 103, average Na 130.2 meq/L) had a higher degree of congestion evident in higher frequency of jugular venous distension (JVD) >12 cmHO (p = 0.007), 2+ lower extremity oedema (p = 0.001), and higher right atrial pressure (p = 0.007), compared with normonatraemic patients (n = 327, average Na 138.6 meq/L). Despite a similar baseline furosemide dose in both groups (median 200 mg), the hyponatraemia group received higher in-hospital furosemide (280 vs. 200 mg, in both groups, respectively, p < 0.001) which represented a higher percentage of furosemide utilisation relative to baseline, compared with the normonatraemia group (33% vs 0%, in both groups respectively, p = 0.007). With in-hospital diuresis, the Na level of hyponatraemic subjects started significantly increasing at discharge and up to 6 months after randomisation-all relative to baseline. Hyponatraemic patients had significantly lower systolic blood pressure (SBP) longitudinally at multiple time points compared with normonataremic patients, but it did not further decrease despite the higher furosemide dose in the former group.
Patients with ADHF and hyponatraemia on admission had a higher degree of congestion and required higher doses of furosemide, compared with normonatraemic subjects. The lower Na and SBP in this instance should not lead to withholding or minimising diuretic dosage which should rather be dictated by volume status.
急性失代偿性心力衰竭（ADHF）患者入院时合并低钠血症与正常钠血症的利尿剂需求尚未得到充分研究。
利用充血性心力衰竭评估研究和肺动脉导管有效性（ESCAPE）试验数据集，检查入院时合并低钠血症或正常钠血症的 ADHF 患者的特征和利尿剂需求。
ADHF 合并入院时低钠血症患者（n=103，平均血钠 130.2meq/L）与正常钠血症患者（n=327，平均血钠 138.6meq/L）相比，颈静脉扩张程度更高（JVD>12cmHO，p=0.007），2+下肢水肿更常见（p=0.001），右心房压力更高（p=0.007），表明充血程度更严重。尽管两组的基础呋塞米剂量相似（中位数 200mg），但低钠血症组在住院期间接受了更高剂量的呋塞米（280mg 与 200mg，p<0.001），与正常钠血症组相比，相对基线，呋塞米的利用率更高（33%与 0%，p=0.007）。随着住院期间的利尿，低钠血症患者的血钠水平在出院时开始显著升高，并持续升高至随机分组后 6 个月-均与基线相比。与正常钠血症患者相比，低钠血症患者的收缩压（SBP）在多个时间点呈进行性下降，但尽管前者组的呋塞米剂量更高，SBP 并未进一步下降。
与正常钠血症患者相比，入院时合并低钠血症的 ADHF 患者充血程度更高，需要更高剂量的呋塞米。在这种情况下，较低的血钠和 SBP 不应导致利尿剂剂量的减少或避免，而应根据容量状态来决定。
