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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/17028

Title: Insufficient Natriuretic Response to Continuous Intravenous Furosemide Is Associated With Poor Long-Term Outcomes in Acute Decompensated Heart Failure
Authors: Singh, Dhssraj
Shrestha, Kevin
Testani, Jeffrey M.
VERBRUGGE, Frederik
Dupont, Matthias
MULLENS, Wilfried
Tang, W. H. Wilson
Issue Date: 2014
Publisher: CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
Citation: JOURNAL OF CARDIAC FAILURE, 20 (6), p. 392-399
Abstract: Background: Treatment of acute decompensated heart failure (ADHF) with loop diuretics, such as furosemide, is frequently complicated by insufficient urine sodium excretion. We hypothesize that insufficient natriuretic response to diuretic therapy, characterized by lower urine sodium (U-Na) and urine furosemide, is associated with subsequent inadequate decongestion, worsening renal function, and adverse long term events. Methods and Results: We enrolled 52 consecutive patients with ADHF and measured serum and urine sodium (U-Na), urine creatinine (U-Cr), and urine furosemide (U-Furosemide) levels on a spot sample taken after treatment with continuous intravenous furosemide, and followed clinical and renal variables as well as adverse long-term clinical outcomes (death, rehospitalizations, and cardiac transplantation). We observed similar correlations between U-Na:U-Furosemide ratio and U-Na and fractional excretion of sodium (FENa) with 24-hour net urine output (r = 0.52-0.64, all P < .01) and 24-hour weight loss (r = 0.44-0.56; all P < .01). Interestingly, FENa (but not U-Na or U-Na:U-Furosemide) were influenced by estimated glomerular filtration rate (eGFR). We observed an association between lower U-Na:U-Furosemide with greater likelihood of worsening renal function (hazard ratio [HR] 3.01; P = .02) and poorer adverse clinical outcomes (HR 1.63, P = .008) after adjusting for age and eGFR. Meanwhile, both diminished weight loss and net fluid output over 24 hours of continuous intravenous furosemide were observed when U-Na:U-Furosemide ratios were <2 mmol/mg or when U-Na <50 mmol. Conclusion: In patients with ADHF receiving continuous furosemide infusion, impaired natriuretic response to furosemide is associated with greater likelihood of worsening renal function and future adverse long-term outcomes, independently from and incrementally with decreasing intrinsic glomerular filtration.
Notes: [Singh, Dhssraj] Univ Kansas, Dept Med, Div Cardiovasc Dis, Kansas City, KS USA. [Shrestha, Kevin; Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH 44195 USA. [Testani, Jeffrey M.] Yale Univ, Univ Sch Med, Dept Internal Med, New Haven, CT USA. [Testani, Jeffrey M.] Yale Univ, Univ Sch Med, Program Appl Translat Res, New Haven, CT USA. [Verbrugge, Frederik H.; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium. [Verbrugge, Frederik H.; Mullens, Wilfried] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. tangw@ccf.org
URI: http://hdl.handle.net/1942/17028
DOI: 10.1016/j.cardfail.2014.03.006
ISI #: 000337070900003
ISSN: 1071-9164
Category: A1
Type: Journal Contribution
Validation: ecoom, 2015
Appears in Collections: Research publications

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