title: Clinical experience with low-dose continuous infusion of furosemide in acute heart failure: assessment of efficacy and safety.
abstract: BACKGROUND
  Clinical data are scarce for furosemide administered as a low-dose (<160 mg/24 hours) continuous intravenous infusion in acute heart failure (HF). Our purpose was to evaluate the efficacy and safety of low-dose continuous infusion of furosemide on diuretic response, renal function, and patient outcomes.
  
  
  METHODS
  A retrospective study of patients with acute HF who received furosemide administered as a continuous infusion after initial therapy with intermittent boluses (usually 40-80 mg every 12 hours). End points included mean hourly urine output, incidence of acute renal injury, and outcome disparities of patients who developed acute renal injury. Comparison of patients with preserved and reduced left ventricular ejection fraction (LVEF) was also performed.
  
  
  RESULTS
  The study included 150 patients (age 57 ± 13 years, male gender 61%, admission weight 87 ± 32 kg, LVEF 37 ± 15%, 28% preserved LVEF). Mean initial and maximum furosemide doses were 5.1 ± 1.1 mg/h and 6.2 ± 2.2 mg/h, respectively. Mean duration of therapy was 51.4 ± 67.5 hours. Continuous infusion of furosemide was associated with a significant increase in mean hourly urine output compared to baseline (150 ± 77 mL/h vs 116 ± 69 mL/h, P < .001). Acute renal injury developed in 19% of patients, with 70% of those occurring within the first 48 hours of therapy. Mean serum creatinine (baseline 1.55 ± 1.50 mg/dL vs at discharge 1.64 ± 1.61 mg/dL, P = .20) and estimated glomerular filtration rate (baseline 67 ± 39 mL/min vs at discharge 67 ± 43 mL/min, P = .89) did not significantly change over the course of the hospitalization. Development of acute renal injury was associated with poorer outcomes, higher furosemide dose, and longer duration of furosemide therapy. Diuretic response and safety were not different between patients with preserved or reduced LVEF.
  
  
  CONCLUSIONS
  In patients with acute HF, furosemide administered as a low-dose continuous infusion was effective in achieving diuresis and was not associated with a detectable effect on renal function. This diuretic approach appeared to be similarly effective and safe in patients with preserved LVEF.
authors.affiliation: School of Pharmacy, University of Southern California, Los Angeles, CA 90033, USA. tienng@usc.edu
authors.forename: Tien M H
authors.initials: TM
authors.lastname: Ng
authors.forename: Shenche
authors.initials: S
authors.lastname: Hshieh
authors.forename: Cynthia Y
authors.initials: CY
authors.lastname: Chan
authors.forename: Uri
authors.initials: U
authors.lastname: Elkayam
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: D004232:Diuretics; D005665:Furosemide