title: Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial.
abstract: BACKGROUND
  We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients.
  
  
  METHODS
  In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background.
  
  
  RESULTS
  Median weight loss: 2.8 kg (0.7, 6.1); mean: 3.7 kg (22% of values <0). Weight loss and maximum in-hospital dose were correlated (p=0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p=0.003), especially at >300 mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r=0.043; p=0.412)
  
  
  CONCLUSIONS
  High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome.
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. victor.hasselblad@duke.edu
authors: Vic
authors: V
authors: Hasselblad
authors: Wendy
authors: W
authors: Gattis Stough
authors: Monica R
authors: MR
authors: Shah
authors: Yuliya
authors: Y
authors: Lokhnygina
authors: Christopher M
authors: CM
authors: O'Connor
authors: Robert M
authors: RM
authors: Califf
authors: Kirkwood F
authors: KF
authors: Adams
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019992:Databases as Topic; D005260:Female; D005665:Furosemide / Q000009:adverse effects; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000187:drug effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D002316:Cardiotonic Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors; D020097:Natriuretic Peptide, Brain; D005665:Furosemide
references: JAMA. 2005 Oct 5;294(13):1625-33
references: 16204662
references: Eur Heart J. 2005 Jan;26(1):11-7
references: 15615794
references: J Card Fail. 2004 Dec;10(6):460-6
references: 15599835
references: JAMA. 2005 Feb 2;293(5):572-80
references: 15687312
references: Am Heart J. 2001 Apr;141(4):528-35
references: 11275915
references: Am Heart J. 2002 Jul;144(1):31-8
references: 12094185
references: Lancet. 1998 Feb 7;351(9100):389-93
references: 9482291
references: Eur J Clin Pharmacol. 1986;31 Suppl:35-42
references: 3780838
references: Clin Pharmacol Ther. 1997 Aug;62(2):187-93
references: 9284855
references: Cardiology. 2009;113(1):12-9
references: 18931492
references: Circulation. 2004 Sep 21;110(12):1514-7
references: 15381655
references: Circulation. 1999 Sep 21;100(12):1311-5
references: 10491376