Diuretic dosing in acute decompensated heart failure: lessons from DOSE.
The mainstay of treatment for acute decompensated heart failure (ADHF) is intravenous (IV) diuretic therapy either as a bolus or via continuous infusion. Despite being available for decades, few randomized trials exist to guide dosing and administration of these drugs. In 2011, the Diuretic Optimization Strategies Evaluation (DOSE) trial used a prospective, randomized design to compare bolus versus continuous infusion of IV furosemide, as well as high-dose versus low-dose therapy. The study found no difference in the primary end point for continuous versus bolus infusion. High-dose diuretics were more effective than low dose without clinically important negative effects on renal function. Although limited by patient selection criteria and protocol design, the study challenges long-held beliefs that continuous infusion is more effective than bolus dosing. The study also challenges the notion that high-dose diuretics carry clinically important renal toxicity risks for patients.
Department of Cardiovascular Medicine, Ochsner Medical Center, 1516 Jefferson Highway, Jefferson, LA 70121, USA.
Patrick T
PT
Campbell
Jason
J
Ryan
D000208:Acute Disease; D000368:Aged; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome
D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide; D003404:Creatinine