Sodium loading in ambulatory patients with heart failure with reduced ejection fraction: Mechanistic insights into sodium handling

Author:

Dauw Jeroen12ORCID,Meekers Evelyne12,Martens Pieter1,Deferm Sébastien1,Dhont Sebastiaan12,Marchal Wouter3,Mesotten Liesbeth4,Dupont Matthias1,Nijst Petra1,Tang W.H. Wilson5,Janssens Stefan P.6,Mullens Wilfried17

Affiliation:

1. Ziekenhuis Oost‐Limburg, Department of Cardiology Genk Belgium

2. UHasselt – Hasselt University, Doctoral School for Medicine and Life Sciences, LCRC Diepenbeek Belgium

3. UHasselt – Hasselt University, Institute for Materials Research (IMO‐IMOMEC) Diepenbeek Belgium

4. Ziekenhuis Oost‐Limburg, Department of Nuclear Medicine Genk Belgium

5. Cleveland Clinic Cleveland OH USA

6. Department of Cardiovascular Diseases University Hospitals Leuven, KU Leuven Leuven Belgium

7. Faculty of Medicine and Life Sciences, LCRC UHasselt – Hasselt University, Biomedical Research Institute Diepenbeek Belgium

Abstract

AimsSodium restriction was not associated with improved outcomes in heart failure patients in recent trials. The skin might act as a sodium buffer, potentially explaining tolerance to fluctuations in sodium intake without volume overload, but this is insufficiently understood. Therefore, we studied the handling of an increased sodium load in patients with heart failure with reduced ejection fraction (HFrEF).Methods and resultsTwenty‐one ambulatory, stable HFrEF patients and 10 healthy controls underwent a 2‐week run‐in phase, followed by a 4‐week period of daily 1.2 g (51 mmol) sodium intake increment. Clinical, echocardiographic, 24‐h urine collection, and bioelectrical impedance data were collected every 2 weeks. Blood volume, skin sodium content, and skin glycosaminoglycan content were assessed before and after sodium loading. Sodium loading did not significantly affect weight, blood pressure, congestion score, N‐terminal pro‐brain natriuretic peptide, echocardiographic indices of congestion, or total body water in HFrEF (all p > 0.09). There was no change in total blood volume (4748 ml vs. 4885 ml; p = 0.327). Natriuresis increased from 150 mmol/24 h to 173 mmol/24 h (p = 0.024), while plasma renin decreased from 286 to 88 μU/L (p = 0.002). There were no significant changes in skin sodium content, total glycosaminoglycan content, or sulfated glycosaminoglycan content (all p > 0.265). Healthy controls had no change in volume status, but a higher increase in natriuresis without any change in renin.ConclusionsSelected HFrEF patients can tolerate sodium loading, with increased renal sodium excretion and decreased neurohormonal activation.

Funder

Limburg Sterk Merk

Publisher

Wiley

Subject

Cardiology and Cardiovascular Medicine

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