Impact of diuretic treatment and sodium intake on plasma volume in patients with compensated systolic heart failure.
OBJECTIVE
In patients with heart failure (HF), the use of diuretics may be a double-edged sword that can alleviate symptoms of congestion, but also result in over-diuresis and intravascular volume depletion. The purpose of the present study was to examine plasma volume (PV) in HF patients receiving from 0 to 160 mg of furosemide and to investigate whether determination of plasma N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) concentrations can predict PV-status.


RESULTS
Plasma volume, extracellular volume, glomerular filtration rate, NT-proBNP, and daily renal sodium excretion were measured in 18 patients with medically treated, compensated HF and in 27 healthy volunteers. Cardiac function was examined by non-invasive cardiac output determination and echocardiography. Exercise capacity was evaluated by 6 min walk test. There was a borderline significant difference in PV between patients with HF and control subjects (37.3 +/- 6.0 and 40.2 +/- 5.8 mL/kg, respectively, P = 0.092) with a significant tendency towards a contraction of PV with increasing use of diuretics (P = 0.031). There was no difference in extracellular volume between patients with HF and control subjects (P = 0.844). NT-proBNP plasma concentrations had no correlation to either sodium excretion (P = 0.193) or PV (P = 0.471) in patients with HF.


CONCLUSIONS
Plasma volume in patients with HF was within normal limits, but patients treated with high doses of loop-diuretics tended to have subnormal PV. Single measurement of NT-proBNP plasma concentration could not be used to estimate intravascular volume status in patients with HF.
Bonfils
Peter K
PK
Department of Clinical Physiology and Nuclear Medicine, Koege Hospital, Copenhagen, Denmark. p_bonfils@post.tele.dk
Damgaard
Morten
M
Taskiran
Mustafa
M
Goetze
Jens Peter
JP
Norsk
Peter
P
Gadsbøll
Niels
N
D000368:Aged; D002302:Cardiac Output / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005080:Exercise Test; D005500:Follow-Up Studies; D005665:Furosemide / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010953:Plasma Volume / Q000187:drug effects* / Q000502:physiology; D011379:Prognosis; D011498:Protein Precursors; D012189:Retrospective Studies; D012964:Sodium / Q000652:urine*; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*
D004232:Diuretics; D010446:Peptide Fragments; D011498:Protein Precursors; D017673:Sodium Chloride, Dietary; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D005665:Furosemide; D012964:Sodium