Association of hyponatremia with increased renin activity in chronic congestive heart failure: Impact of diuretic therapy

Schaer, Gary L.; Covit, Andrew B.; Laragh, John H.; Cody, Robert J.

doi:10.1016/0002-9149(83)90200-x

Cited by 36 publications

(13 citation statements)

References 13 publications

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“…Studies have consistently reported that persistent hyponatremia in heart failure characterizes a population that has more advanced disease, with more pronounced neurohumoral activation, and higher risk of adverse clinical outcomes, which is corroborated by the current analysis [6, 11, 12]. As the DOSE AHF data uniquely provide prospectively collected plasma renin activity and plasma aldosterone levels at baseline and discharge, it was shown that persistent hyponatremia in acute heart failure was associated with exceedingly high plasma renin activity levels during decongestive treatment, even in the contemporary area of neurohumoral blocker treatment.…”

Section: Discussionsupporting

confidence: 83%

Transient Hyponatremia During Hospitalization for Acute Heart Failure

Verbrugge

Grodin

Mullens

et al. 2016

The American Journal of Medicine

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Objective To study whether the temporal pattern of transient hyponatremia development in acute heart failure might provide insight into its pathophysiology and prognostic relevance. Methods A post-hoc analysis of the ESCAPE and DOSE AHF studies was performed (n=716). Patients were stratified according to the temporal pattern of hyponatremia development: (1) no hyponatremia; (2) persistent hyponatremia; (3) decompensation hyponatremia disappearing with decongestive treatment; and (4) treatment-induced hyponatremia. Results Transient decompensation versus no hyponatremia was associated with significantly elevated blood urea nitrogen/creatinine ratio (P-value<0.001), plasma renin activity (P-value<0.001), and plasma aldosterone levels (P-value<0.001) at baseline. Disease severity characteristics of such patients were intermediate between no and persistent hyponatremia. In contrast, patients with treatment-induced versus no hyponatremia had similar baseline characteristics, comparable natriuretic peptide levels, and both groups had little neurohumoral activation at baseline. Diuretic efficacy, defined as net fluid balance [mL] per 40 mg furosemide-equivalent dose administered, was lower in patients with persistent or treatment-induced hyponatremia versus decompensation hyponatremia or no hyponatremia, respectively. The former versus latter groups also had more pronounced neurohumoral activation with decongestive treatment. The risk for all-cause mortality [HR (95%CI) = 2.50 (1.50-4.19); P-value<0.001] and death or heart failure readmission [HR (95%CI) = 2.18 (1.60-2.97); P-value<0.001] was significantly elevated in patients with persistent versus no hyponatremia, with the risk of decompensation and treatment-hyponatremia situated in-between. Conclusions Transient hyponatremia is prognostically relevant, but has a heterogeneous etiology according to its temporal pattern of development.

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Section: Discussionsupporting

confidence: 83%

Transient Hyponatremia During Hospitalization for Acute Heart Failure

Verbrugge

Grodin

Mullens

et al. 2016

The American Journal of Medicine

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“…In our study, as well as in others [11,13], [sNa + ] was related to PRA, but its clinical utility as an index of PRA is restricted to only a few patients with advanced CHF, namely those with hyponatremia, while most CHF patients with increased PRA show normal [sNa + ] values (Group B, Table ). Our data confirm that patients with hyponatremia (Group C) have a marked RAS activation and a low renal perfusion pressure, as suggested by the increased BUN/serum creatinine ratio and the reduced mean arterial systemic pressure (Table ).…”

Section: Discussionsupporting

confidence: 66%

“…Hyponatremia, defined as a serum sodium concentration ([sNa + ]) <136 mEq l −1 , often complicates the clinical course of patients with CHF [11]. It is considered an index of compromised renal perfusion, increased RAS activity and poor CHF prognosis [11–15]. Nevertheless, hyponatremia is detectable in only a few patients with advanced CHF.…”

Section: Introductionmentioning

confidence: 99%

Serum to urinary sodium concentration ratio is an estimate of plasma renin activity in congestive heart failure

Marenzi

Lauri

Assanelli

et al. 2002

European J of Heart Fail

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“…However, the pathogenesis of hyponatremia in edematous patients is much-debated and has not been completely elucidated yet. Particularly, some authors argue in favor of a causative role of particular biohumoral patterns (poorly controlled RAAS overactivation [8,9,10], excess of BNP release [11,12], relative adrenal insufficiency [13,14]), and controversial therapeutic approaches (intensive intravenous diuretic therapy [4,6], and thiazides [15,16]), regarding both the pathogenesis and persistence over time of this electrolyte trouble.…”

Section: Hyponatremia and Chronic Heart Failurementioning

confidence: 99%

RETRACTED: Vasopressin Receptor Antagonists for the Correction of Hyponatremia in Chronic Heart Failure: An Underutilized Therapeutic Option in Current Clinical Practice?

Vecchis

Cantatrione

Mazzei

et al. 2016

JCM

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In the congestive heart failure (CHF) setting, chronic hyponatremia is very common. The present review aims at addressing topics relevant to the pathophysiology of hyponatremia in the course of CHF as well as its optimal treatment, including the main advantages and the limitations resulting from the use of the available dietary and pharmacological measures approved for the treatment of this electrolytic trouble. A narrative review is carried out in order to represent the main modalities of therapy for chronic hyponatremia that frequently complicates CHF. The limits of usual therapies implemented for CHF-related chronic hyponatremia are outlined, while an original analysis of the main advancements achieved with the use of vasopressin receptor antagonists (VRAs) is also executed. The European regulatory restrictions that currently limit the use of VRAs in the management of CHF are substantially caused by financial concerns, i.e., the high costs of VRA therapy. A thoughtful reworking of current restrictions would be warranted in order to enable VRAs to be usefully associated to loop diuretics for decongestive treatment of CHF patients with hyponatremia.

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Association of hyponatremia with increased renin activity in chronic congestive heart failure: Impact of diuretic therapy

Cited by 36 publications

References 13 publications

Transient Hyponatremia During Hospitalization for Acute Heart Failure

Transient Hyponatremia During Hospitalization for Acute Heart Failure

Serum to urinary sodium concentration ratio is an estimate of plasma renin activity in congestive heart failure

RETRACTED: Vasopressin Receptor Antagonists for the Correction of Hyponatremia in Chronic Heart Failure: An Underutilized Therapeutic Option in Current Clinical Practice?

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