Current Management of Hyponatremia in Acute Heart Failure: A Report From the Hyponatremia Registry for Patients With Euvolemic and Hypervolemic Hyponatremia (HN Registry)

Abstract

BackgroundHyponatremia (HN) occurs commonly in patients with acute heart failure and confers a worse prognosis. Current HN treatment varies widely, with no consensus. This study recorded treatment practices currently used for patients hospitalized with acute heart failure and HN.Methods and ResultsData were collected prospectively from 146 US sites on patients hospitalized with acute heart failure and HN (serum sodium concentration [Na+] ≤130 mEq/L) present at admission or developing in the hospital. Baseline variables, HN treatment, and laboratory values were recorded. Of 762 patients, median [Na+] was 126 mEq/L (interquartile range, 7) at baseline and increased to 130 mEq/L at discharge. Fluid restriction was the most commonly prescribed therapy (44%), followed by no specific HN treatment beyond therapy for congestion (23%), isotonic saline (5%), tolvaptan (4%), and hypertonic saline (2%). Median rate of change in [Na+] varied by treatment (0.5 [interquartile range, 1.0] to 2.3 [8.0] mEq/L/d) and median treatment duration ranged from 1 (interquartile range, 1) to 6 (5) days. Fluid restriction and no specific HN treatment resulted in similar changes in [Na+], and were least effective in correcting HN. Few patients (19%) had [Na+] ≥135 mEq/L at discharge.ConclusionsThe most commonly used treatment approaches for HN (fluid restriction and no specific treatment) in acute heart failure increased [Na+] minimally, and most patients remained hyponatremic at discharge.

Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction – A report from FAR NHL prospective registry

“…In case of gout, the aim is to maintain a serum urate level below 357 μmol/l [ 1 ]. In case of hyponatraemia, restriction of fluids is imposed most frequently, followed by infusions of isotonic and hypertonic solutions of natrium and tolvaptan [ 27 ]. Unfortunately, treatment by tolvaptan, a vasopressin receptor antagonist which significantly increases natrium levels in patients with hyponatraemia, did not demonstrate any effect on the long-term mortality of HFrEF patients [ 28 ].…”

Evidence for Effective Multiple K+-Current Inhibitions by Tolvaptan, a Non-peptide Antagonist of Vasopressin V2 Receptor

“…Synergistic antagonism of vasopressin V 2 receptor and inhibition of these K + currents caused by TLV at the concentrations noted to be achievable in humans (Shoaf et al, 2007; Kato et al, 2016; Oguri et al, 2018a), may also potentially account for its actions on renal epithelial cells. Therefore, determining to what extent such inhibitory actions by TLV or other structurally similar compounds (Tabata et al, 2017) contribute to their therapeutic effectiveness in renal water excretion is worthy of being imperatively investigated, as they have been rampantly used in different types of electrolyte disorders such as hyponatremia (Izumi et al, 2014; Aylwin et al, 2015; Verbalis et al, 2016; Clark et al, 2017; Der-Nigoghossian et al, 2017; Dunlap et al, 2017; Felker et al, 2017; Konstam et al, 2017; Wu et al, 2017a; Berardi et al, 2018; Kogure et al, 2018; Matsukawa et al, 2018; Morris et al, 2018; Sigal et al, 2018; Vidic et al, 2019).…”

“…Tolvaptan (TLV; Samsca® or Jinarc®) is recognized as an oral aquaretic agent that functions as a selective, competitive antagonist of vasopressin V 2 receptor used to treat hyponatremia associated with congestive heart failure, cirrhosis, or the syndrome of inappropriate antidiuretic hormone (Izumi et al, 2014; Aylwin et al, 2015; Verbalis et al, 2016; Clark et al, 2017; Der-Nigoghossian et al, 2017; Dunlap et al, 2017; Felker et al, 2017; Konstam et al, 2017; Wu et al, 2017a; Berardi et al, 2018; Kogure et al, 2018; Matsukawa et al, 2018; Morris et al, 2018; Oguri et al, 2018a; Sigal et al, 2018; Takimura et al, 2018; Vidic et al, 2019). It was noted to be effective at improving the hyponatremic conditions that may occur in different pathologic conditions including that following pituitary surgery (Izumi et al, 2014; Janneck et al, 2014; Ahluwalia et al, 2015; Aylwin et al, 2015; Ichimura et al, 2015; Gralla et al, 2017; Berardi et al, 2018).…”

Reduced ejection fraction heart failure – new data from multicenter studies and national registries regarding general and elderly populations: hopes and disappointments

“… 2 More subtle indicators include hyponatremia (which may be more useful for predicting prognosis than hypopotassemia, especially in chronic patients) and hypoalbuminemia (which, left unsupervised, may lead to unexpected therapeutic failure). 3 , 4 The reduced volume filling in patients with impaired systolic output has greater effects on the duration and the quality of life than reduced pulmonary and systemic volume loading. The tendency to hospitalize patients for depletion, without sufficient attention to the previously highlighted parameters, may lead to increased mortality rates during the first month after discharge, compared with the mortality recorded during hospitalization, leading to disillusionment concerning the prospects for long-term therapeutic control.…”