Sodium chloride versus glucose solute as a volume replacement therapy for more effective decongestion in acute heart failure (SOLVRED-AHF) - A prospective, randomized, mechanistic study

Q: What question did the study aim to address in acute heart failure?

The study tested whether sodium/chloride restriction is essential for effective decongestion and compared decongestive effects of two isotonic infusion strategies added to diuretic therapy.

Q: How were patients treated in the randomized trial?

Patients were randomized 1:1 to continuous infusions of 0.9% NaCl or 5% glucose for 48 hours alongside protocolized diuretic therapy.

Q: What were the main outcomes comparing NaCl versus glucose?

NaCl led to higher urine output and natriuresis, required lower cumulative loop diuretic dosing, and showed mechanistic evidence consistent with inhibited proximal tubular sodium reabsorption.

Sep 29, 2026

Uploaded by Nguyễn Văn Học

Long-standing sodium/chloride restriction assumptions in acute heart failure decongestion were challenged by comparing isotonic infusions added to protocolized diuretic therapy. In a prospective, single-centre, randomized, single-blind design, patients with fluid overload received continuous 0.9% NaCl or 5% glucose infusions for 48 hours. The NaCl strategy improved urine output and natriuresis and reduced total loop diuretic exposure, with mechanistic findings consistent with inhibited proximal tubular sodium reabsorption.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Aims

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Results

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Introduction

European Journal of Heart Failure (2025) 27, 2442–2451 RESEARCH ARTICLE doi:10.1002/ejhf.3708 Sodium chloride versus glucose solute as a volume replacement therapy for more effective decongestion in acute heart failure (SOLVRED-AHF): A prospective, randomized, mechanistic study Jan Biegus 1*†, Gracjan Iwanek1†, Jeffrey Testani2, Robert Zymli ski 1, Marat Fudim3,4, Mateusz Guzik1, Piotr Gajewski 1, and Piotr Ponikowski 1 1 Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; 2 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; 3 Division of Cardiology, Duke University Medical Center, Durham, NC, USA; and 4 Duke Clinical Research Institute, Durham, NC, USA Received 2 1 March 2025; revised 23 April 2025; accepted 8 May 2025 ; online publish-ahead-of-print 2 June 2025 Aims We questioned the long-standing paradigm that sodium/chloride restriction is essential for effective decongestion in acute heart failure (AHF). This study compared the decongestive effects of two isotonic infusion strategies: 5% glucose (for intravascular volume repletion only) versus 0.9% NaCl (providing additional sodium/chloride supplementation), both added to protocolized diuretic therapy. ............................................................... ................................................................ ...................................... Methods This single-centre, prospective, randomized, single-blind study included patients with fluid overload who were and results randomized 1: 1 to continuous infusions (83.3 ml/h) of either 0.9% NaCl or 5% glucose for 48 h. Co-primary endpoints included 24-and 48-h urine output, natriuresis within 48 h, and total furosemide dose up to 48 h. The NaCl group (n = 25) significantly outperformed glucose group (n = 25) in all co-primary endpoints: the median urine output was higher in the NaCl group versus glucose group at 24 and 48 h (cumulative during 48 h: 9500 vs. 7395 ml, p = 0.001), the NaCl group had higher natriuresis during 48 h of decongestion (p < 0.05), which was achieved with lower cumulative doses of furosemide (220 vs. 280 mg, p = 0.02). The fractional excretion of lithium was higher in the NaCl versus glucose group (19.0 ± 8.9% vs. 14.7 ± 9.6%, p = 0.030), indicating inhibited proximal tubular sodium reabsorption. There was no difference in absolute distal reabsorption, but relative distal sodium reabsorption in the NaCl group was lower (86.9 ± 12.3% vs. 91.5 ± 9.3%, p < 0.001). ............................................................... ................................................................ ...................................... Conclusions The infusion of NaCl compared to glucose added to diuretic therapy led to significantly higher diuresis, natriuresis, and lower loop diuretic use, driven by lower sodium avidity and inhibition of proximal tubular sodium reabsorption. Clinical Trial Registration: ClinicalTrials.gov NCT05962255. .......................................................................................................... *Corresponding author. Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Borowska 213, Poland. Tel: +48 71 7331112, Email: [jan.biegus@umw.edu.pl](jan.biegus@umw.edu.pl), [janbiegus@gmail.com](janbiegus@gmail.com) †Contributed equally. © 2025 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Graphical Abstract The impact of sodium chloride (NaCl) supplementation on proximal and distal tubular reabsorption in acute heart failure (AHF). .................................

FAQs

What question did the study aim to address in acute heart failure?

The study tested whether sodium/chloride restriction is essential for effective decongestion and compared decongestive effects of two isotonic infusion strategies added to diuretic therapy.

How were patients treated in the randomized trial?

Patients were randomized 1:1 to continuous infusions of 0.9% NaCl or 5% glucose for 48 hours alongside protocolized diuretic therapy.

What were the main outcomes comparing NaCl versus glucose?

NaCl led to higher urine output and natriuresis, required lower cumulative loop diuretic dosing, and showed mechanistic evidence consistent with inhibited proximal tubular sodium reabsorption.

Sep 29, 2026

Uploaded by Nguyễn Văn Học