title: Loop diuretic strategies in patients with acute decompensated heart failure: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The safety and efficacy of continuous infusion vs bolus injection of intravenous loop diuretics to treat acute decompensated heart failure were debated. Our aim is to compare the administration routes of diuretics in hospitalized patients with acute decompensated heart failure.
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the effects of continuous infusion vs bolus administration of loop diuretics in patients with acute decompensated heart failure. The primary end points were urine outputs, body weight loss, all causes of mortality, and death from cardiovascular causes. Secondary end points were electrolyte imbalance, change in creatinine levels, tinnitus or hearing loss, and days of hospitalization.
  
  
  RESULTS
  Ten randomized controlled trials with 518 patients were identified. Continuous infusion of diuretics was associated with a significantly greater weight loss (weighted mean difference, 0.78; 95% confidence interval, 0.03-1.54) compared with bolus injection. Urine output, the incidence of electrolyte imbalance, change in creatinine level, length of hospitalization, the incidence of ototoxicity, cardiac mortality, and all-cause mortality showed no significant differences between the 2 groups.
  
  
  CONCLUSIONS
  Meta-analysis of the existing limited studies did not confirm any significant differences in the safety and efficacy with continuous administration of loop diuretic, compared with bolus injection in patients with acute decompensated heart failure.
authors: Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
authors: Mei-Yi
authors: MY
authors: Wu
authors: Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Nen-Chung
authors: NC
authors: Chang
authors: School of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan; Department of Thoracic Internal Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
authors: Chien-Ling
authors: CL
authors: Su
authors: Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
authors: Yung-Ho
authors: YH
authors: Hsu
authors: Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Taipei Medical Hospital, Taipei, Taiwan.
authors: Tzen-Wen
authors: TW
authors: Chen
authors: Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Yuh-Feng
authors: YF
authors: Lin
authors: Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.
authors: Chih-Hsiung
authors: CH
authors: Wu
authors: Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan. Electronic address: kelvintam@h.tmu.edu.tw.
authors: Ka-Wai
authors: KW
authors: Tam
mesh_terms: D000208:Acute Disease; D003422:Critical Care; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D016032:Randomized Controlled Trials as Topic; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016482:Urinalysis; D015431:Weight Loss
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide
keywords: Diuretics; Furosemide; Heart failure; Meta-analysis