Skip to main content

Advertisement

Springer Nature Link
Log in

Hyponatremia in heart failure

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Hyponatremia is the most common electrolyte abnormality found in hospitalized patients with heart failure. It may occur in patients who have hypovolemic, hypervolemic, or euvolemic state. It is usually not corrected by available therapies. It is a major predictor of prognosis, and correction of hyponatremia can be effectively accomplished by vasopressin antagonists. However, it still remains to be seen whether the normalization of serum sodium with vasopressin antagonists will also lead to an improved long-term prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Janicic N, Verbalis JG (2003) Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin North Am 32:459–481. doi:10.1016/S0889-8529(03)00004-5

    Article  PubMed  CAS  Google Scholar 

  2. Hawkins RC (2003) Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta 337:169–172. doi:10.1016/j.cccn.2003.08.001

    Article  PubMed  CAS  Google Scholar 

  3. Adrogué HJ, Madias NE (2000) Hyponatremia. N Engl J Med 342:1581–1589. doi:10.1056/NEJM200005253422107

    Article  PubMed  Google Scholar 

  4. Anderson RJ, Chung H-M, Kluge R, Schrier RW (1985) Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med 102:164–168

    PubMed  CAS  Google Scholar 

  5. Fall PJ (2000) Hyponatremia and hypernatremia: a systematic approach to causes and their correction. Postgrad Med 107:75–82

    PubMed  CAS  Google Scholar 

  6. Oren RM (2005) Hyponatremia in congestive heart failure. Am J Cardiol 95:2B–7B. doi:10.1016/j.amjcard.2005.03.002

    Article  PubMed  CAS  Google Scholar 

  7. Sica DA (2005) Hyponatremia and heart failure—pathophysiology and implications. Congest Heart Fail 11:274–277

    Article  PubMed  Google Scholar 

  8. Movig KL, Leufkens HG, Lenderink AW, Egberts AC (2003) Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia. J Clin Epidemiol 56:530–535. doi:10.1016/S0895-4356(03)00006-4

    Article  PubMed  CAS  Google Scholar 

  9. Fried LF, Palevsky PM (1997) Hyponatremia and hypernatremia. Med Clin North Am 81:585–609. doi:10.1016/S0025-7125(05)70535-6

    Article  PubMed  CAS  Google Scholar 

  10. Klein L, O’Connor CM, Leimberger JD, Gattis-Stough W, Pina IL, Felker GM et al for the OPTIME-CHF investigators (2005) Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the OPTIME-CHF study. Circulation 111:2454–2460. doi:10.1161/01.CIR.0000165065.82609.3D

    Google Scholar 

  11. Gheorghiade M, Hellkamp AS, Pina IL et al (2005) Hemodynamic characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial. J Am Coll Cardiol 45(suppl):145A [Abstract]

    Google Scholar 

  12. Schrier RW, Abraham WT (1999) Hormones and hemodynamics in heart failure. N Engl J Med 341:577–585. doi:10.1056/NEJM199908193410806

    Article  PubMed  CAS  Google Scholar 

  13. Schuster VL, Kokko JP, Jacobson HR (1984) Angiotensin II directly stimulates sodium transport in rabbit proximal convoluted tubules. J Clin Invest 73:507–515. doi:10.1172/JCI111237

    Article  PubMed  CAS  Google Scholar 

  14. Goldsmith SR, Francis GS, Cowley AW Jr (1986) Arginine vasopressin and the renal response to water loading in congestive heart failure. Am J Cardiol 58:295–299. doi:10.1016/0002-9149(86)90065-2

    Article  PubMed  CAS  Google Scholar 

  15. Schrier RW, Berl T, Anderson RJ (1979) Osmotic and non-osmotic control of vasopressin release. Am J Physiol 236:F321–F332

    PubMed  CAS  Google Scholar 

  16. Greenberg A (2000) Diuretic complications. Am J Med Sci 319:10–24. doi:10.1097/00000441-200001000-00002

    Article  PubMed  CAS  Google Scholar 

  17. De Luca L, Klein L, Udelson JE, Orlandi C, Sardella G, Fedele F et al (2005) Hyponatremia in patients with heart failure. Am J Cardiol 96:19L–23L. doi:10.1016/j.amjcard.2005.09.066

    PubMed  Google Scholar 

  18. Chin MH, Goldman L (1996) Correlates of major complications or death in patients admitted to the hospital with congestive heart failure. Arch Intern Med 156:1814–1820. doi:10.1001/archinte.156.16.1814

    Article  PubMed  CAS  Google Scholar 

  19. Chen MC, Chang HW, Cheng CI, Chen YH, Chai HT (2003) Risk stratification of in-hospital mortality in patients hospitalized for chronic congestive heart failure secondary to non-ischemic cardiomyopathy. Cardiology 100:136–142. doi:10.1159/000073931

    Article  PubMed  Google Scholar 

  20. Lee WH, Packer M (1986) Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. Circulation 73:257–267

    PubMed  CAS  Google Scholar 

  21. Lee DS, Austin PC, Rouleau JL (2003) Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 290:2581–2587. doi:10.1001/jama.290.19.2581

    Article  PubMed  CAS  Google Scholar 

  22. Felker GM, Leimberger JD, Califf RM, Cuffe MS, Massie BM, Adams KF Jr et al (2004) Risk stratification after hospitalization for decompensated heart failure. J Card Fail 10:460–466. doi:10.1016/j.cardfail.2004.02.011

    Article  PubMed  Google Scholar 

  23. O’Connor CM, Adams KF, Gattis WA et al (2005) Predictors of mortality in patients hospitalized with worsening heart failure: insight from the ACTIV in CHF trial. J Am Coll Cardiol 45(suppl):151A [Abstract]

    Google Scholar 

  24. Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM (1995) A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333:1190–1195. doi:10.1056/NEJM199511023331806

    Article  PubMed  CAS  Google Scholar 

  25. Krumholz HM, Chen YT, Bradford WD, Cerese J (1999) Variations in and correlates of length of stay in academic hospitals among patients with heart failure resulting from systolic dysfunction. Am J Manag Care 5:715–723

    PubMed  CAS  Google Scholar 

  26. Kearney MT, Fox KA, Lee AJ, Brooksby WP, Shah AM, Flapan A et al (2004) Predicting sudden death in patients with mild to moderate chronic heart failure. Heart 90:1137–1143. doi:10.1136/hrt.2003.021733

    Article  PubMed  CAS  Google Scholar 

  27. Cuffe MS, Califf RM, Adams KF Jr, Benza R, Bourge R, Colucci WS et al (2002) Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 287:1541–1547. doi:10.1001/jama.287.12.1541

    Article  PubMed  CAS  Google Scholar 

  28. Gheorghiade M, Gattis WA, O’Connor CM, Adams KF Jr, Elkayam U, Barbagelata A et al & Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Congestive Heart Failure (ACTIV in CHF) Investigators (2004) Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA 291:1963–1971. doi:10.1001/jama.291.16.1963

    Google Scholar 

  29. Binanay C, Califf RM, Hasselblad V, O’Connor CM, Shah MR, Sopko G et al & ESCAPE Investigators and ESCAPE Study Coordinators (2005) Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 294:1625–1633. doi:10.1001/jama.294.13.1625

    Google Scholar 

  30. Lilly LS, Dzau VJ, Williams GH, Rydstedt L, Hollenberg NK (1984) Hyponatremia in congestive heart failure: implications for neurohormonal activation and responses to orthostasis. J Clin Endocrinol Metab 59:924–930

    Article  PubMed  CAS  Google Scholar 

  31. Dzau VJ, Packer M, Lilly LS, Swartz SL, Hollenberg NK, Williams GH (1984) Prostaglandins in severe congestive heart failure: relation to activation of the renin-angiotensin system and hyponatremia. N Engl J Med 310:347–352

    PubMed  CAS  Google Scholar 

  32. Brater C (2000) Diuretic therapy in congestive heart failure. Congest Heart Fail 6:197–201

    PubMed  Google Scholar 

  33. Rai A, Whaley-Connell A, McFarlane S, Sowers JR (2006) Hyponatremia, arginine vasopressin dysregulation, and vasopressin receptor antagonism. Am J Nephrol 26:579–589. doi:10.1159/000098028

    Article  PubMed  Google Scholar 

  34. Quittnat F, Gross P (2006) Vaptans and the treatment of water-retaining disorders. Semin Nephrol 26:234–243. doi:10.1016/j.semnephrol.2006.02.003

    Article  PubMed  CAS  Google Scholar 

  35. Ghali JK, Koren MJ, Taylor JR, Brooks-Asplund E, Fan K, Long WA et al (2006) Efficacy and safety of oral conivaptan: a V1A/V2 vasopressin receptor antagonist, assessed in a randomized, placebo-controlled trial in patients with euvolemic or hypervolemic hyponatremia. J Clin Endocrinol Metab 91:2145–2152. doi:10.1210/jc.2005-2287

    Article  PubMed  CAS  Google Scholar 

  36. Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS et al; SALT Investigators (2006) Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med 355:2099–2112. doi:10.1056/NEJMoa065181

    Google Scholar 

  37. Gheorghiade M, Konstam MA, Burnett JC Jr et al (2007) Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST Clinical Status Trials. JAMA 297:1332–1343. doi:10.1001/jama.297.12.1332

    Article  PubMed  CAS  Google Scholar 

  38. Konstam MA, Gheorghiade M, Burnett JC Jr et al (2007) Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA 297:1319–1331. doi:10.1001/jama.297.12.1319

    Article  PubMed  CAS  Google Scholar 

  39. Abraham WT, Shamshirsaz AA, McFann K, Oren RM, Schrier RW (2006) 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. J Am Coll Cardiol 47:1615–1621. doi:10.1016/j.jacc.2005.11.071

    Article  PubMed  CAS  Google Scholar 

  40. Rossi J, Bayram M, Udelson JE et al (2007) Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) trial. Acute Card Care 9(2):82–86. doi:10.1080/17482940701210179

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece

    Dimitrios Farmakis, Gerasimos Filippatos, John Parissis & Dimitrios Th. Kremastinos

  2. 28 Doukissis Plakentias St, 11523, Athens, Greece

    Gerasimos Filippatos

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Mihai Gheorghiade

Authors
  1. Dimitrios Farmakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gerasimos Filippatos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Parissis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dimitrios Th. Kremastinos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mihai Gheorghiade
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerasimos Filippatos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Farmakis, D., Filippatos, G., Parissis, J. et al. Hyponatremia in heart failure. Heart Fail Rev 14, 59–63 (2009). https://doi.org/10.1007/s10741-008-9109-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-008-9109-7

Keywords

Search

Navigation