title: Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy.
abstract: BACKGROUND
  Obesity could attenuate diuretic effectiveness in treatment of acute decompensated heart failure (HF).
  
  
  RESULTS
  The DOSE trial randomized 308 subjects with acute HF to low- versus high-intensification intravenous diuretic therapy. We tested for statistical interactions between obesity and dosing strategy across clinical end points. After 72 hours of treatment, obese subjects (body mass index >30 kg/m(2); n = 173) had greater volume loss than nonobese subjects (n = 119) but similar improvements in dyspnea and freedom from congestion. Both groups had greater fluid loss with high-intensification treatment. Obese subjects had a higher incidence of worsening renal function (WRF) at 72 hours with low-intensification treatment, compared with nonobese subjects. In contrast, nonobese and obese subjects had similar incidence of WRF with high-intensification treatment. There were no differences between obese and nonobese subjects in time to discharge and 60-day freedom from death, emergency department visit, or rehospitalization.
  
  
  CONCLUSIONS
  The incidence of WRF was greater in obese than in nonobese subjects with low-intensification treatment. However, the frequency of WRF was equivalent in obese and nonobese subjects with high-intensification treatment. Additional studies are needed to assess whether obese patients with acute HF benefit from an initial high-intensification treatment strategy.
authors.affiliation: Division of Cardiology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Achal
authors.initials: A
authors.lastname: Gupta
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: Steven
authors.initials: S
authors.lastname: McNulty
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: E Michael
authors.initials: EM
authors.lastname: Gilbert
authors.forename: Rami
authors.initials: R
authors.lastname: Alharethi
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Steven R
authors.initials: SR
authors.lastname: Goldsmith
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: David A
authors.initials: DA
authors.lastname: Bull
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D007677:Kidney Function Tests / Q000639:trends; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D004232:Diuretics