Safety and Efficacy of Low Dose Hypertonic Saline Solution and High Dose Furosemide for Congestive Heart Failure

Currently, congestive heart failure (CHF) is the fastest growing heart-related diagnosis in
North America, with the chance of a person experiencing it during their lifetime around 20%.
In patients with CHF, acute decompensation requiring hospitalizations are common. Patients
with renal insufficiency are more susceptible to worsening of renal function or overt renal
failure in relation to an episode of decompensated heart failure. Thus, there is a great
need for treatment to help patients with renal dysfunction that can simultaneously protect
them from further renal deterioration. Preliminary evidence indicates that hypertonic
saline solution (HSS) combined with high dose loop diuretics may improve the prognosis for
patients with CHF. In two separate studies, this treatment was found to alleviate symptoms
of CHF, and significantly reduce hospital length of stay, as well as reduce morbidity and
mortality subsequent to hospital stay. So far, available studies have demonstrated that
renal function is not compromised when using HSS and high dose furosemide as a treatment for
CHF. Preliminary data from our institution suggests that low volume HSS combined with high
dose furosemide may be beneficial for patients with renal insufficiency.

Hypothesis:

High dose furosemide in combination with low volume HSS provides effective diuretic response
and has a beneficial effect on preservation of renal function while in hospital as compared
to pulse furosemide in patients with pre-treatment renal impairment (GFR < 60 mL/min).