000151458 001__ 151458 000151458 005__ 20251017144615.0 000151458 0247_ $$2doi$$a10.1002/ejhf.3597 000151458 0248_ $$2sideral$$a143172 000151458 037__ $$aART-2025-143172 000151458 041__ $$aeng 000151458 100__ $$aNúñez, Julio 000151458 245__ $$aSalt repletion and diuretic response: The role of serum chloride. A post-hoc analysis of the <scp>SALT</scp>-<scp>HF</scp> trial on furosemide and hypertonic saline solution administration in ambulatory patients with worsening heart failure 000151458 260__ $$c2025 000151458 5203_ $$aAims The efficacy of combining hypertonic saline solution (HSS) with loop diuretics in worsening heart failure (WHF) remains uncertain. Hypochloraemia has been associated with reduced diuretic efficacy. Some authors propose that chloride repletion may enhance natriuretic and diuretic responses. This post-hoc analysis of the SALT-HF trial evaluated the effect of single-dose administration of HSS plus intravenous (IV) furosemide versus IV furosemide, stratified by baseline serum chloride. Methods and results The analysis included 148 ambulatory patients with WHF from the double-blind, randomized SALT-HF trial. Participants received either an IV single dose of HSS plus furosemide or IV furosemide. The endpoints were 3-h urinary sodium excretion and diuresis, 7-day congestion score, and 30-day adverse events according to chloride levels. Multivariable linear and logistic regression models assessed the relationship between the intervention and the endpoints. The mean baseline serum chloride level was 100 ± 4 mmol/L. Sixteen patients (10.8%) were identified as hypochloraemic (serum chloride <96 mmol/L), balanced between treatment groups. Patients with hypochloraemia showed a lower natriuretic response (p < 0.05). Interaction analysis revealed a between-treatment differential natriuretic effect based on the chloride levels (pinteraction = 0.008). HSS plus furosemide increased natriuresis compared to furosemide at lower chloride levels. No differential between-treatment effect was found for 3-h diuresis. Similar heterogeneous results were found for the 7-day clinical congestion score and 30-day heart failure events, with a benefit with HSS in patients with lower chloride levels. Conclusion In ambulatory patients with WHF and hypochloraemia, adding HSS to furosemide may improve short-term natriuretic response and outcomes. These findings suggest that chloride supplementation may help overcome diuretic resistance in these patients. 000151458 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/PI20-00689 000151458 540__ $$9info:eu-repo/semantics/closedAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/ 000151458 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000151458 700__ $$aMiñana, Gema 000151458 700__ $$ade la Espriella, Rafael 000151458 700__ $$aZegrí-Reiriz, Isabel 000151458 700__ $$aComín-Colet, Josep 000151458 700__ $$0(orcid)0000-0002-4769-7154$$aRubio Gracia, Jorge$$uUniversidad de Zaragoza 000151458 700__ $$aMorales-Rull, Jose Luis 000151458 700__ $$aLlàcer, Pau 000151458 700__ $$aDiez-Villanueva, Pablo 000151458 700__ $$ade Juan Bagudá, Javier 000151458 700__ $$aOrtiz Cortés, Carolina 000151458 700__ $$aGoirigolzarri-Artaza, Josebe 000151458 700__ $$aGarcía-Pinilla, Jose Manuel 000151458 700__ $$aBarrios, Elvira 000151458 700__ $$adel Prado Díaz, Susana 000151458 700__ $$aJiménez-Marrero, Santiago 000151458 700__ $$aRestrepo-Córdoba, Maria Alejandra 000151458 700__ $$aTestani, Jeffrey 000151458 700__ $$aCobo Marcos, Marta 000151458 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina 000151458 773__ $$g(2025), [12 pp.]$$pEur. j. heart fail.$$tEuropean Journal of Heart Failure$$x1388-9842 000151458 8564_ $$s2385500$$uhttps://zaguan.unizar.es/record/151458/files/texto_completo.pdf$$yVersión publicada 000151458 8564_ $$s2019285$$uhttps://zaguan.unizar.es/record/151458/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000151458 909CO $$ooai:zaguan.unizar.es:151458$$particulos$$pdriver 000151458 951__ $$a2025-10-17-14:18:49 000151458 980__ $$aARTICLE