title: Comparison of bumetanide- and metolazone-based diuretic regimens to furosemide in acute heart failure.
abstract: BACKGROUND
  Limited data exist comparing the efficacy and safety of bumetanide- or metolazone-based diuretic regimens to furosemide in acute heart failure (HF). Our purpose was to evaluate the comparative effect on urine output (UO) and renal function between these regimens.
  
  
  METHODS
  A retrospective study of hospitalized HF patients treated with continuous infusion furosemide (CIF), combination furosemide plus metolazone (F + M), or continuous infusion bumetanide (CIB). Primary end points were between regimen comparisons for change in mean hourly UO versus baseline and incidence of worsening renal function.
  
  
  RESULTS
  Data on 242 patients with acute HF (age 58 ± 12 years, 63% male, left ventricular ejection fraction 38% ± 17%) were analyzed (160 CIF, 42 F + M, 40 CIB). The mean duration of diuretic regimens was 41 ± 32 hours. Compared to baseline, all regimens increased mean hourly UO (P < .0001 for all), with greater increases with F + M (109 ± 171 mL) and CIB (90 ± 90 mL) compared to CIF (48 ± 103 mL; P = .009). Incidence of worsening renal function was not different between regimens; however, blood urea nitrogen (BUN) tended to increase more with F + M (4.4 ± 9.8 mg/dL) and CIB (4.3 ± 9.7 mg/dL) than CIF (1.8 ± 10.8 mg/dL), P = .09. The incidence of hyponatremia was higher with F + M and CIB. Differences in UO, BUN, and hyponatremia were retained in the subgroup analysis limited to patients with baseline serum creatinine <1.5 mg/dL, where renal function between the groups was not different.
  
  
  CONCLUSIONS
  Compared to CIF, F + M or CIB was associated with greater increases in UO. No difference in the incidence of worsening renal function was found; however, electrolyte abnormalities may be more prevalent when furosemide is combined with metolazone or when bumetanide is used. These therapeutic differences warrant prospective study.
authors.affiliation: University of Southern California School of Pharmacy and Keck School of Medicine, Los Angeles, CA 90033, USA. tienng@usc.edu
authors.forename: Tien M H
authors.initials: TM
authors.lastname: Ng
authors.forename: Erica
authors.initials: E
authors.lastname: Konopka
authors.forename: Alifiya F
authors.initials: AF
authors.lastname: Hyderi
authors.forename: Shenche
authors.initials: S
authors.lastname: Hshieh
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tsuji
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Kim
authors.forename: Song Y
authors.initials: SY
authors.lastname: Han
authors.forename: Duc H
authors.initials: DH
authors.lastname: Phan
authors.forename: Aaron I
authors.initials: AI
authors.lastname: Jeng
authors.forename: Mimi
authors.initials: M
authors.lastname: Lou
authors.forename: Uri
authors.initials: U
authors.lastname: Elkayam
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001806:Blood Urea Nitrogen; D002034:Bumetanide / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000652:urine; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008788:Metolazone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014556:Urine / Q000502:physiology
chemical_list: D004232:Diuretics; D002034:Bumetanide; D005665:Furosemide; D008788:Metolazone
keywords: bumetanide; diuretics; furosemide; heart failure; metolazone