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Sodium and Water Excretion Abnormalities in Congestive Heart Failure: Determinant Factors and Clinical Implications

BERTRAND METTAUER, M.D.; JEAN-LUCIEN ROULEAU, M.D.; DANIEL BICHET, M.D.; CARL JUNEAU, M.D.; CLAUDE KORTAS, M.D.; JEAN-NOEL BARJON, M.D.; and JACQUES de CHAMPLAIN, M.D., Ph.D.
[+] Article and Author Information

Grant support: in part by grants from the Canadian Heart Foundation, the Medical Research Council of Canada, the Fonds de la recherche en santé du Québec, and the René Ste-Marie Research Fund. Dr. Rouleau is a scholar of the Medical Research Council of Canada, Dr. Bichet is a scholar of the Canadian Heart Foundation, and Dr. de Champlain is a career investigator of the J. C. Edwards Foundation.

▸Requests for reprints should be addressed to Jean-Lucien Rouleau, M.D.; Research Center, Hôpital du Sacré-Coeur, 5400 Gouin Boulevard West; Montréal, Quebec, Canada H4J 1C5.


Montreal, Quebec, Canada


© 1986 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1986;105(2):161-167. doi:10.7326/0003-4819-105-2-161
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The renal hemodynamic and neurohumoral determinants of sodium and water excretion abnormalities were studied in 66 patients with severe chronic congestive heart failure. Abnormalities were not closely related to any one variable but were the result of the convergence of a number of determinants. The most important determinants for sodium excretion were activation of the renin-angiotensin system and ventricular function; and the most important for water excretion were plasma vasopressin, plasma norepinephrine, and renal and ventricular functions. In a subgroup of patients, neurohumoral overactivation led to severe sodium and water excretion abnormalities and to increased furosemide requirements. A 17-month follow-up of all 66 patients showed a less favorable clinical course for this subgroup even when compared with hemodynamically matched patients.

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