Loop Diuretics Administration and Acute Heart Failure
Summary
Intravenous loop diuretics is the therapy most commonly used to treat pulmonary congestion and systemic fluid overload. In theory, continuous infusion should allow for a more consistent diuresis, avoiding the sodium reabsorption in the distal tubule as well as the neurohormonal activation. This should lead to renal function improvement and BNP decrease.
Timeline
- Start
- 2010-04
- Primary completion
- 2016-06
- Completion
- 2017-12-28
Outcome
Mixed primary results
registry MEAN Urine Output in cIV: 2505 (Standard Deviation 796) mL NCT01441245 ↗
registry MEAN Urine Output in iIV: 2140 (Standard Deviation 468) mL NCT01441245 ↗
registry Urine Output in cIV vs Urine Output in iIV; p = 0.04; t-test, 2 sided NCT01441245 ↗
registry MEAN Creatinine at Discharge in cIV: 1.78 (Standard Deviation 0.5) mg/dL NCT01441245 ↗
registry MEAN Creatinine at Discharge in iIV: 1.51 (Standard Deviation 0.3) mg/dL NCT01441245 ↗
registry Creatinine at Discharge in cIV vs Creatinine at Discharge in iIV; p = 0.01; t-test, 2 sided NCT01441245 ↗
registry MEAN BNP Change in cIV: -525 (Standard Deviation 615) pg/mL NCT01441245 ↗
registry MEAN BNP Change in iIV: -148 (Standard Deviation 463) pg/mL NCT01441245 ↗
registry BNP Change in cIV vs BNP Change in iIV; p = 0.03; t-test, 2 sided NCT01441245 ↗
paper There were three co-primary endpoints assessed from admission to discharge: the mean paired changes in serum creatinine, estimated glomerular filtration rate (eGFR), and reduction in B-type natriuretic peptide (BNP). PMID 24974232 ↗
paper The continuous infusion arm had a greater reduction in BNP over the hospital course, (-576 ± 655 versus -181 ± 527 pg/ml P = 0.02). PMID 24974232 ↗
Publications
- Background Palazzuoli A, Pellegrini M, Franci B, Beltrami M, Ruocco G, Gonnelli S, Angelini GD, Nuti R. Short and long-term effects of continuous versus intermittent loop diuretics treatment in acute heart failure with renal dysfunction. Intern Emerg Med. 2015 Feb;10(1):41-9. doi: 10.1007/s11739-014-1112-5. Epub 2014 Aug 3.
- Results Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O'Connor CM; NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797-805. doi: 10.1056/NEJMoa1005419.
- Ruocco G, Feola M, Nuti R, Luschi L, Evangelista I, Palazzuoli A. Loop Diuretic Administration in Patients with Acute Heart Failure and Reduced Systolic Function: Effects of Different Intravenous Diuretic Doses and Diuretic Response Measurements. J Clin Med. 2019 Nov 2;8(11):1854. doi: 10.3390/jcm8111854.
- Ruocco G, Evangelista I, Franci B, Lucani B, Martini S, Nuti R, Palazzuoli A. Combination of ST2 and B-type natriuretic peptide in diabetic patients with acute heart failure: relation with ventricular stiffness and outcome. J Cardiovasc Med (Hagerstown). 2019 Feb;20(2):81-90. doi: 10.2459/JCM.0000000000000741.
- Palazzuoli A, Pellegrini M, Ruocco G, Martini G, Franci B, Campagna MS, Gilleman M, Nuti R, McCullough PA, Ronco C. Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial. Crit Care. 2014 Jun 28;18(3):R134. doi: 10.1186/cc13952.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Furosemide | Other / unclassified | — | Intravenous |