Abstract 18891: Importance of Sodium Level Trajectory in Acute Heart Failure

Background: Hyponatremia is a common electrolyte disorder which is strongly associated with poor prognosis in acute heart failure (AHF); however, the prognostic impact of the sodium level trajectory has not been determined. Methods: A secondary analysis of the AQUAMARINE study in which patients with AHF and renal impairment (eGFR < 60 mL/min/1.73 m2) were randomized to receive either tolvaptan or conventional treatment was performed. Sodium levels were evaluated at baseline, 6, 12, 24, and 48 hours after randomization. We defined ‘sodium dipping’ as sodium level falling below the baseline level at any timepoint. All patients were categorized into a dipping or non-dipping group. The primary endpoint was the combined event of all-cause death and heart failure rehospitalization. Results: The analysis included 184 patients with a median follow-up of 21.1 months. Sodium levels more steeply increased during the 48 hours in patients without events as compared to sodium levels in patients with events (P=0.033). T...