Hyponatraemia in heart failure: time for new solutions?

Area of Science:

• Cardiology
• Nephrology
• Endocrinology

Background:

• Hyponatraemia (low sodium) is prevalent in heart failure (HF), particularly in decompensated states.
• It signifies advanced disease and is linked to increased mortality and morbidity.
• Understanding causes guides treatment, historically focusing on water restriction, diuretics, or sodium repletion.

Purpose of the Study:

• To review the impact of established and emerging heart failure therapies on sodium balance.
• To focus on the effects of dual vasopressin antagonists, angiotensin receptor-neprilysin inhibitors, SGLT2 inhibitors, and hypertonic saline.
• To propose a therapeutic strategy for managing hyponatraemia in heart failure patients.

Main Methods:

• Literature review of established and emerging heart failure therapies.
• Analysis of their effects on sodium homeostasis and hyponatraemia.
• Synthesis of findings to propose a treatment algorithm.

Main Results:

• Established therapies like diuretics and water restriction have specific roles but limitations.
• Emerging therapies (dual vasopressin antagonists, ARNIs, SGLT2 inhibitors) show promise in improving sodium balance.
• Hypertonic saline remains a tool for severe symptomatic hyponatraemia.

Conclusions:

• Optimizing sodium homeostasis is crucial in heart failure management.
• Emerging HF therapies offer new avenues for addressing hyponatraemia.
• A tailored therapeutic approach integrating these agents is proposed for hyponatraemia in HF.