Hypertonic saline with furosemide for the treatment of acute congestive heart failure: a systematic review and meta-analysis

Int J Cardiol. 2014 May 1;173(2):139-45. doi: 10.1016/j.ijcard.2014.03.020. Epub 2014 Mar 14.


Background: Advanced congestive heart failure (CHF) therapies include intravenous inotropic agents, change in class of diuretics, and venous ultrafiltration or hemodialysis. These modalities have not been associated with improved prognosis and are limited by availability and cost. Compared to high-dose furosemide alone, concomitant hypertonic saline solution (HSS) administration has demonstrated improved clinical outcomes with good safety profile.

Methods: A literature search was conducted for randomized controlled trials that investigated the use of HSS in patients admitted to hospital with acute CHF.

Results: 1032 patients treated with HSS and 1032 controls, demonstrated decreased all-cause mortality in patients treat with HSS with RR of 0.56 (95% CI 0.41-0.76,p=0.0003). 1012 patients treated with HSS and 1020 controls, demonstrated decreased heart failure hospital readmission with RR of 0.50 (95% CI 0.33-0.76,p=0.001). Patients treated with HSS also demonstrated decreased hospital length of stay (p=0.0002), greater weight loss (p<0.00001), and preservation of renal function (p<0.00001).

Conclusion: The results of this meta-analysis demonstrate that in patients with advanced CHF concomitant hypertonic saline administration improved weight loss, preserved renal function, and decreased length of hospitalization, mortality and heart failure rehospitalization. A future adequately powered, multi-centre, placebo controlled, randomized, double dummy, blinded trial is needed to assess the benefit of hypertonic saline in patients with renal dysfunction, in diverse patient populations, as well using a patient population on optimal current heart failure treatment. Pending further validation, there is promise for hypertonic saline as an advanced therapy for the management of acute advanced CHF.

Keywords: Diuretic resistance; Heart failure; Hypertonic saline; Sodium.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acute Disease
  • Diuretics / administration & dosage*
  • Furosemide / administration & dosage*
  • Heart Failure / drug therapy*
  • Humans
  • Randomized Controlled Trials as Topic
  • Saline Solution, Hypertonic / administration & dosage*


  • Diuretics
  • Saline Solution, Hypertonic
  • Furosemide