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Hyponatraemia in heart failure: time for new solutions?
  1. Agnieszka Kapłon-Cieślicka1,
  2. Anzhela Soloveva2,
  3. Yura Mareev3,4,
  4. Irina Cabac-Pogorevici5,
  5. Frederik Hendrik Verbrugge6,7,
  6. Panagiotis Vardas8,9
  1. 1 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
  2. 2 Department of Cardiology, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
  3. 3 Department of Cardiology, National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russian Federation
  4. 4 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
  5. 5 Department of Cardiology, State University of Medicine and Pharmacy 'Nicolae Testemitanu', Chisinau, Moldova (the Republic of)
  6. 6 Department of Cardiology, Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
  7. 7 Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
  8. 8 Heart Sector, Hygeia Hospitals Groups, Athens, Greece
  9. 9 Medical School, Cardiology Department, University of Crete, Heraclion, Greece
  1. Correspondence to Dr Anzhela Soloveva, Department of Cardiology, Almazov National Medical Research Centre, 194156 Saint Petersburg, Russian Federation; anzhela.soloveva{at}


Hyponatraemia is very common in heart failure (HF), especially in decompensated patients. It is associated with increased mortality and morbidity and considered a marker of advanced disease. Recognition of hyponatraemia and its causes may help guide treatment strategy. Historically, therapy has primarily focused on water restriction, decongestion with loop diuretics in case of volume overload (dilutional hyponatraemia) and sodium repletion in case of depletion. In this review, we summarise the potential benefits of established and emerging HF therapies on sodium homeostasis, with a focus on dual vasopressin antagonists, angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors and hypertonic saline, and propose a potential therapeutic approach for hyponatraemia in HF.

  • heart failure
  • drug monitoring

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  • AK-C and AS are joint first authors.

  • AK-C and AS contributed equally.

  • Contributors All persons who meet the authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript.

  • Funding AS was supported by a grant from the Ministry of Science and Higher Education of the Russian Federation (agreement #075-15-2020-800). FHV is supported by the Special Research Fund (BOF) of Hasselt University (BOF19PD04).

  • Competing interests AK-C has received speaker fees from Angelini Pharma, Bayer, KRKA and Servier, outside the submitted work. YM reports consulting payments from AstraZeneca, Novartis, Boehringer Ingelheim, Vifor, Bayer and Servier, outside the submitted work. FHV has received speakers' fees and fees for advisory roles from Novartis and Boehringer Ingelheim, outside the submitted work. PV declares consultancy fees from Hygeia Hospitals Group (HHG), Athens, Greece, from Servier International, Paris, France, and from Dean Medicus, UK.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.