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International Journal of Nephrology
Volume 2011, Article ID 732746, 7 pages
http://dx.doi.org/10.4061/2011/732746
Review Article

Hyponatremia and Congestive Heart Failure: A Marker of Increased Mortality and a Target for Therapy

1Divsions of Nephrology and Critical Care, University of Alberta, Edmonton, AB, Canada T6G 2G3
2Division of Critical Care, University of Alberta, Edmonton, AB, Canada T6G 2G3
3Divsion of Nephrology, University of Virginia Health System, Charlottesville, Box 800133, VA 22911, USA

Received 2 August 2010; Accepted 23 February 2011

Academic Editor: Anjay Rastogi

Copyright © 2011 Adam Romanovsky et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. W. Rosamond, K. Flegal, K. Furie et al., “Heart disease and stroke statistics-2008 update: a report from the American heart association statistics committee and stroke statistics subcommittee,” Circulation, vol. 117, no. 4, pp. e25–e46, 2008. View at Publisher · View at Google Scholar · View at Scopus
  2. D. A. Sica et al., “Sodium and water retention in heart failure and diuretic therapy: basic mechanisms,” Cleveland Clinic Journal of Medicine, vol. 73, supplement 2, pp. S30–S33, 2006. View at Google Scholar
  3. A. Goldberg, H. Hammerman, S. Petcherski et al., “Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction,” Archives of Internal Medicine, vol. 166, no. 7, pp. 781–786, 2006. View at Publisher · View at Google Scholar · View at Scopus
  4. L. De Luca, L. Klein, J. E. Udelson et al., “Hyponatremia in patients with heart failure,” The American Journal of Cardiology, vol. 96, no. 12, pp. 19L–23L, 2005. View at Google Scholar · View at Scopus
  5. C. R. Lee, M. L. Watkins, J. H. Patterson et al., “Vasopressin: a new target for the treatment of heart failure,” American Heart Journal, vol. 146, no. 1, pp. 9–18, 2003. View at Publisher · View at Google Scholar · View at Scopus
  6. S. E. Ishikawa and R. W. Schrier, “Pathophysiological roles of arginine vasopressin and aquaporin-2 in impaired water excretion,” Clinical Endocrinology, vol. 58, no. 1, pp. 1–17, 2003. View at Publisher · View at Google Scholar · View at Scopus
  7. S. R. Goldsmith, “Vasopressin as vasopressor,” American Journal of Medicine, vol. 82, no. 6, pp. 1213–1219, 1987. View at Google Scholar · View at Scopus
  8. S. Nielsen, T. H. Kwon, B. M. Christensen, D. Promeneur, J. Frøkiær, and D. Marples, “Physiology and pathophysiology of renal aquaporins,” Journal of the American Society of Nephrology, vol. 10, no. 3, pp. 647–663, 1999. View at Google Scholar · View at Scopus
  9. F. L. Dunn, T. J. Brennan, A. E. Nelson, and G. L. Robertson, “The role of blood osmolality and volume in regulating vasopressin secretion in the rat,” The Journal of Clinical Investigation, vol. 52, no. 12, pp. 3212–3219, 1973. View at Google Scholar · View at Scopus
  10. P. H. Baylis, “Posterior pituitary function in health and disease,” Clinics in Endocrinology and Metabolism, vol. 12, no. 3, pp. 747–770, 1983. View at Google Scholar · View at Scopus
  11. N. B. Pedersen, M. V. Hofmeister, L. L. Rosenbaek, J. Nielsen, and R. A. Fenton, “Vasopressin induces phosphorylation of the thiazide-sensitive sodium chloride cotransporter in the distal convoluted tubule,” Kidney International, vol. 78, no. 2, pp. 160–169, 2010. View at Publisher · View at Google Scholar · View at Scopus
  12. K. Mutig, T. Saritas, S. Uchida et al., “Short-term stimulation of the thiazide-sensitive Na+-C1- cotransporter by vasopressin involves phosphorylation and membrane translocation,” American Journal of Physiology, vol. 298, no. 3, pp. F502–F509, 2010. View at Publisher · View at Google Scholar · View at Scopus
  13. B. F. Uretsky, J. G. Verbalis, and T. Generalovich, “Plasma vasopressin response to osmotic and hemodynamic stimuli in heart failure,” American Journal of Physiology, vol. 17, no. 3, pp. H396–H402, 1985. View at Google Scholar · View at Scopus
  14. S. R. Goldsmith, G. S. Francis, and A. W. Cowley, “Arginine vasopressin and the renal response to water loading in congestive heart failure,” American Journal of Cardiology, vol. 58, no. 3, pp. 295–299, 1986. View at Google Scholar · View at Scopus
  15. G. S. Francis, C. Benedict, D. E. Johnstone et al., “Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the studies of left ventricular dysfunction (SOLVD),” Circulation, vol. 82, no. 5, pp. 1724–1729, 1990. View at Google Scholar · View at Scopus
  16. E. V. Sivukhina, I. U. E. Morozov, A. A. Dolzhikov, G. F. Jirikowski, and V. Grinevich, “Comparison of vasopressin and oxytocin expressions in the hypothalamo-neurohypophysial system of patients with chronic heart failure,” Hormone and Metabolic Research, vol. 42, no. 1, pp. 56–60, 2010. View at Publisher · View at Google Scholar · View at Scopus
  17. A. Kazory, “Hyponatremia in heart failure: revisiting pathophysiology and therapeutic strategies,” Clinical Cardiology, vol. 33, no. 6, pp. 322–329, 2010. View at Publisher · View at Google Scholar · View at Scopus
  18. D. A. Sica and T. W. B. Gehr, “Diuretic combinations in refractory oedema states: pharmacokinetic-pharmacodynamic relationships,” Clinical Pharmacokinetics, vol. 30, no. 3, pp. 229–249, 1996. View at Google Scholar · View at Scopus
  19. B. K. Krämer, F. Schweda, and G. A. J. Riegger, “Diuretic treatment and diuretic resistance in heart failure,” American Journal of Medicine, vol. 106, no. 1, pp. 90–96, 1999. View at Publisher · View at Google Scholar · View at Scopus
  20. K. Swedberg, U. Idanpaan-Heikkila, and J. Remes, “Effects of enalapril on mortality in severe congestive heart failure. Results of the cooperative north scandinavian enalapril survival study (CONSENSUS),” The New England Journal of Medicine, vol. 316, no. 23, pp. 1429–1435, 1987. View at Google Scholar
  21. S. Yusuf, “Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure,” The New England Journal of Medicine, vol. 325, no. 5, pp. 293–302, 1991. View at Google Scholar · View at Scopus
  22. S. Yusuf, J. M. Nicklas, G. Timmis et al., “Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions,” The New England Journal of Medicine, vol. 327, no. 10, pp. 685–691, 1992. View at Google Scholar · View at Scopus
  23. M. Sonnenblick, Y. Friedlander, and A. J. Rosin, “Diuretic-induced severe hyponatremia review and analysis of 129 reported patients,” Chest, vol. 103, no. 2, pp. 601–606, 1993. View at Google Scholar · View at Scopus
  24. P. A. Sarafidis, P. I. Georgianos, and A. N. Lasaridis, “Diuretics in clinical practice. Part II: electrolyte and acid-base disorders complicating diuretic therapy,” Expert Opinion on Drug Safety, vol. 9, no. 2, pp. 259–273, 2010. View at Publisher · View at Google Scholar · View at Scopus
  25. A. Kazory, “Hyponatremia in heart failure: revisiting pathophysiology and therapeutic strategies,” Clinical Cardiology, vol. 33, no. 6, pp. 322–329, 2010. View at Publisher · View at Google Scholar · View at Scopus
  26. G. S. Francis, R. M. Siegel, and S. R. Goldsmith, “Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis,” Annals of Internal Medicine, vol. 103, no. 1, pp. 1–6, 1985. View at Google Scholar · View at Scopus
  27. L. Klein, C. M. O'Connor, J. D. Leimberger et al., “Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the outcomes of a prospective trial of intravenous milrinone for exacerbations of chronic heart failure (OPTIME-CHF) study,” Circulation, vol. 111, no. 19, pp. 2454–2460, 2005. View at Publisher · View at Google Scholar
  28. M. Gheorghiade, W. A. Gattis, C. M. O'Connor et al., “Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial,” Journal of the American Medical Association, vol. 291, no. 16, pp. 1963–1971, 2004. View at Publisher · View at Google Scholar
  29. W. H. Lee and M. Packer, “Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure,” Circulation, vol. 73, no. 2, pp. 257–267, 1986. View at Google Scholar · View at Scopus
  30. M. Gheorghiade, W. T. Abraham, N. M. Albert et al., “Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry,” European Heart Journal, vol. 28, no. 8, pp. 980–988, 2007. View at Publisher · View at Google Scholar
  31. M. Gheorghiade, J. S. Rossi, W. Cotts et al., “Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial,” Archives of Internal Medicine, vol. 167, no. 18, pp. 1998–2005, 2007. View at Publisher · View at Google Scholar · View at Scopus
  32. L. S. Lilly, V. J. Dzau, and G. H. Williams, “Hyponatremia in congestive heart failure: implications for neurohumoral activation and responses to orthostasis,” Journal of Clinical Endocrinology and Metabolism, vol. 59, no. 5, pp. 924–930, 1984. View at Google Scholar · View at Scopus
  33. G. V. Ramani, P. A. Uber, and M. R. Mehra, “Chronic heart failure: contemporary diagnosis and management,” Mayo Clinic Proceedings, vol. 85, no. 2, pp. 180–195, 2010. View at Publisher · View at Google Scholar · View at Scopus
  34. B. Pitt, F. Zannad, W. J. Remme et al., “The effect of spironolactone on morbidity and mortality in patients with severe heart failure,” The New England Journal of Medicine, vol. 341, no. 10, pp. 709–717, 1999. View at Publisher · View at Google Scholar
  35. B. Pitt, W. Remme, F. Zannad et al., “Epleronone post-acute myocardial infarction heart failure efficacy and survival study investigators. Epleronone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction,” The New England Journal of Medicine, vol. 351, pp. 543–551, 2004. View at Google Scholar
  36. D. D. Shin, F. Brandimarte, L. De Luca et al., “Review of current and investigational pharmacologic agents for acute heart failure syndromes,” American Journal of Cardiology, vol. 99, no. 2, pp. S4–S23, 2007. View at Publisher · View at Google Scholar · View at Scopus
  37. G. S. Francis, R. M. Siegel, S. R. Goldsmith et al., “Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis,” Annals of Internal Medicine, vol. 103, no. 1, pp. 1–6, 1985. View at Google Scholar · View at Scopus
  38. A. Ahmed, A. Husain, T. E. Love et al., “Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods,” European Heart Journal, vol. 27, no. 12, pp. 1431–1439, 2006. View at Publisher · View at Google Scholar · View at Scopus
  39. V. Hasselblad, W. G. Stougha, M. R. Shahb et al., “Relation between diuretic dose and outcome in a heart failure population: results of the ESCAPE trial,” Journal of Cardiac Failure, vol. 9, no. 10, pp. 1064–1069, 2005. View at Google Scholar
  40. A. Ohnishi, Y. Orita, N. Takagi et al., “Aquaretic effect of a potent, orally active, nonpeptide V antagonist in men,” Journal of Pharmacology and Experimental Therapeutics, vol. 272, no. 2, pp. 546–551, 1995. View at Google Scholar · View at Scopus
  41. L. M. Burrell, P. A. Phillips, J. Risvanis, R. K. Chan, K. L. Aldred, and C. I. Johnston, “Long-term effects of nonpeptide vasopressin V2 antagonist OPC-31260 in heart failure in the rat,” American Journal of Physiology, vol. 275, no. 1, pp. H176–H182, 1998. View at Google Scholar · View at Scopus
  42. T. Hirano, Y. Yamamura, S. Nakamura, T. Onogawa, and T. Mori, “Effects of the V2-receptor antagonist OPC-41061 and the loop diuretic furosemide alone and in combination in rats,” Journal of Pharmacology and Experimental Therapeutics, vol. 292, no. 1, pp. 288–294, 2000. View at Google Scholar · View at Scopus
  43. M. Georghiade et al., “Tolvaptan Investigators. Vasopressin V2-recepto blockadw tih tovaptan in patients with chronic heart failure: results from a double-blind randomized control trial,” Circulation, vol. 107, pp. 2690–2696, 2003. View at Google Scholar
  44. M. Gheorghiade, M. A. Konstam, J. C. Burnett Jr. et al., “Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials,” Journal of the American Medical Association, vol. 297, no. 12, pp. 1332–1343, 2007. View at Publisher · View at Google Scholar
  45. M. A. Konstam, M. Gheorghiade, J. C. Burnett Jr. et al., “Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial,” Journal of the American Medical Association, vol. 297, no. 12, pp. 1319–1331, 2007. View at Publisher · View at Google Scholar
  46. W. T. Abraham, A. A. Shamshirsaz, K. McFann, R. M. Oren, and R. W. Schrier, “Aquaretic effect of lixivaptan, an oral, non-peptide, selective V2 receptor vasopressin antagonist, in New York heart association functional class II and III chronic heart failure patients,” Journal of the American College of Cardiology, vol. 47, no. 8, pp. 1615–1621, 2006. View at Publisher · View at Google Scholar · View at Scopus
  47. D. Zeltser, S. Rosansky, H. Van Rensburg, J. G. Verbalis, and N. Smith, “Assessment of the efficacy and safety of intravenous conivaptan in euvolemic and hypervolemic hyponatremia,” American Journal of Nephrology, vol. 27, no. 5, pp. 447–457, 2007. View at Publisher · View at Google Scholar · View at Scopus
  48. J. E. Udelson, W. B. Smith, G. H. Hendrix et al., “Acute hemodynamic effects of conivaptan, a dual V and V vasopressin receptor antagonist, in patients with advanced heart failure,” Circulation, vol. 104, no. 20, pp. 2417–2423, 2001. View at Google Scholar · View at Scopus
  49. S. R. Goldsmith, U. Elkayam, W. H. Haught, A. Barve, and W. He, “Efficacy and safety of the vasopressin V1A/V2-receptor antagonist conivaptan in acute decompensated heart failure: a dose-ranging pilot Study,” Journal of Cardiac Failure, vol. 14, no. 8, pp. 641–647, 2008. View at Publisher · View at Google Scholar · View at Scopus
  50. S. R. Goldmsith, U. Elkayam, B. McNutt et al., “Combined effects of conivaptan and furosemide on urine output in patients with acute decompensated heart failure,” Critical Care Medicine, vol. 36, p. A61, 2008. View at Google Scholar