Research Progress on Serum Sodium Concentration and Heart Failure Risk
DOI:
https://doi.org/10.53469/jcmp.2025.07(02).31Keywords:
Heart failure, Serum sodium, Arginine VasopressinAbstract
Heart failure is one of the major chronic diseases worldwide, with increasing prevalence and healthcare burden. Hyponatremia is common among heart failure patients, with a prevalence ranging from 8% to 28%, and is associated with disease progression, as well as higher mortality and morbidity. The etiology is complex, involving neuroendocrine abnormalities, medication effects, and other factors. In both heart failure with preserved and reduced ejection fraction, hyponatremia is linked to higher mortality, though the mechanisms and impact differ. Treatment requires consideration of the type of hyponatremia, volume status, and severity of heart failure. Recently, vasopressin antagonists such as tolvaptan have shown promising therapeutic potential. This article reviews the relationship between serum sodium levels and heart failure risk, as well as treatment strategies, providing a reference for clinical practice.
References
Abebe, T. B. et al. The prognosis of heart failure patients: Does sodium level play a significant role? PLoS One 13, e0207242 (2018).
Avcı, B. K. et al. Relation between serum sodium levels and clinical outcomes in Turkish patients hospitalized for heart failure: a multi-center retrospective observational study. Anatol J Cardiol 17, 2-7 (2017).
Rodriguez, M. et al. Hyponatremia in Heart Failure: Pathogenesis and Management. Curr Cardiol Rev 15, 252-261 (2019).
Luo, X., Jin, Q. & Wu, Y. Tolvaptan add-on therapy in patients with acute heart failure: A systematic review and meta-analysis. Pharmacol Res Perspect 8, e00614 (2020).
Holland-Bill, L. et al. Hyponatremia and mortality risk: a Danish cohort study of 279 508 acutely hospitalized patients. Eur J Endocrinol 173, 71-81 (2015).
Waikar, S. S., Mount, D. B. & Curhan, G. C. Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122, 857-865 (2009).
Corona, G. et al. The Economic Burden of Hyponatremia: Systematic Review and Meta-Analysis. Am J Med 129, 823-835.e4 (2016).
Imamura, T. et al. Low cardiac output stimulates vasopressin release in patients with stage d heart failure. Circ J 78, 2259-2267 (2014).
Onuigbo, M. A. C. RAAS inhibition and cardiorenal syndrome. Curr Hypertens Rev 10, 107-111 (2014).
Rusinaru, D. et al. Relation of Serum Sodium Level to Long-Term Outcome After a First Hospitalization for Heart Failure With Preserved Ejection Fraction. American Journal of Cardiology 103, 405-410 (2009).
Bavishi, C. et al. Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions. Am J Cardiol 113, 1834-1838 (2014).
Sato, Y. et al. Hyponatremia at discharge is associated with adverse prognosis in acute heart failure syndromes with preserved ejection fraction: a report from the JASPER registry. Eur Heart J Acute Cardiovasc Care 8, 623-633 (2019).
Park, J. J. et al. Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction: An analysis of the Korean Acute Heart Failure registry. Int J Cardiol 248, 239-245 (2017).
Fröhlich, H. et al. Peritoneal ultrafiltration in end-stage chronic heart failure. Clin Kidney J 8, 219-225 (2015).
Nodari, S., Jao, G. T. & Chiong, J. R. Clinical utility of tolvaptan in the management of hyponatremia in heart failure patients. Int J Nephrol Renovasc Dis 3, 51-60 (2010).
Pose, A. et al. Benefit of tolvaptan in the management of hyponatraemia in patients with diuretic-refractory congestive heart failure: the SEMI-SEC project. ESC Heart Fail 4, 130-137 (2017).
Rask, K. A., Deis, T., Larsson, J. E., Rossing, K. & Gustafsson, F. Hyponatremia in Stable Patients with Advanced Heart Failure: Association to Hemodynamics and Outcome. Cardiology 148, 187-194 (2023).
Spasovski, G. et al. Hyponatraemia diagnosis and treatment clinical practice guidelines. Nefrologia 37, 370-380 (2017).
Hoorn, E. J. & Zietse, R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. Journal of the American Society of Nephrology 28, 1340 (2017).
Spasovski, G. et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med 40, 320-331 (2014).
Wan, Y. et al. Impact of Compound Hypertonic Saline Solution on Decompensated Heart Failure. Int Heart J 58, 601-607 (2017).
Lafrenière, G. et al. Effects of hypertonic saline solution on body weight and serum creatinine in patients with acute decompensated heart failure. World J Cardiol 9, 685-692 (2017).
Kazory, A. Hyponatremia in heart failure: revisiting pathophysiology and therapeutic strategies. Clin Cardiol 33, 322-329 (2010).
Oren, R. M. Hyponatremia in Congestive Heart Failure. The American Journal of Cardiology 95, 2-7 (2005).
Filippatos, T. D. & Elisaf, M. S. Hyponatremia in patients with heart failure. World J Cardiol 5, 317-328 (2013).
Bikdeli, B. et al. Intravenous Fluids in Acute Decompensated Heart Failure. JACC: Heart Failure 3, 127-133 (2015).
Licata, G. et al. Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: Long-term effects. American Heart Journal 145, 459-466 (2003).
Vinod, P., Krishnappa, V., Chauvin, A. M., Khare, A. & Raina, R. Cardiorenal Syndrome: Role of Arginine Vasopressin and Vaptans in Heart Failure. Cardiol Res 8, 87-95 (2017).
Lin, T. E., Adams, K. F. & Patterson, J. H. Potential Roles of Vaptans in Heart Failure: Experience from Clinical Trials and Considerations for Optimizing Therapy in Target Patients. Heart Failure Clinics 10, 607-620 (2014).
Hirano, T., Yamamura, Y., Nakamura, S., Onogawa, T. & Mori, T. Effects of the V(2)-receptor antagonist OPC-41061 and the loop diuretic furosemide alone and in combination in rats. J Pharmacol Exp Ther 292, 288-294 (2000).
Konstam, M. A. et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA 297, 1319-1331 (2007).
Hauptman, P. J. et al. Clinical course of patients with hyponatremia and decompensated systolic heart failure and the effect of vasopressin receptor antagonism with tolvaptan. J Card Fail 19, 390-397 (2013).
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