title: Diuretic response in patients with acute decompensated heart failure: characteristics and clinical outcome--an analysis from RELAX-AHF.
abstract: OBJECTIVE
  We studied the characteristics and clinical outcome related to diuretic response and the effects of serelaxin in patients hospitalized for acute heart failure (AHF).
  
  
  RESULTS
  RELAX-AHF was a double-blind, placebo-controlled trial, enrolling 1161 patients admitted to hospital for AHF who were randomized to 48 h i.v infusions of placebo or serelaxin (30 µg/kg per day) within 16 h from presentation. Diuretic response was defined as Δ weight kg/[(total i.v. dose)/40 mg] + [(total oral dose)/80 mg)] furosemide (or equivalent loop diuretic dose) up to day 5. Median diuretic response was -0.42 (-1.00, -0.14) kg/40 mg. A poor diuretic response was independently associated with Western-like region (Western Europe, North America, Israel, and Poland), lower diastolic blood pressure, the absence of oedema, higher blood urea nitrogen, and lower levels of aspartate aminotransferase and potassium (all P < 0.01). Randomization to serelaxin was associated with lower doses of i.v. loop diuretics and slightly less weight loss, resulting in a neutral effect on diuretic response. Worse diuretic response was independently associated both with less relief of dyspnoea, measured with a visual analogue scale (VAS) at day 5 (primary endpoint; P = 0.0002), and with a higher risk of cardiovascular death or rehospitalization for heart failure or renal failure through day 60 (secondary endpoint, P < 0.0001), but not with increased 180-day cardiovascular mortality (P = 0.507).
  
  
  CONCLUSIONS
  In patients hospitalized for AHF, a poor diuretic response was associated with a poor in-hospital and early post-discharge clinical outcome. Serelaxin had a neutral effect on diuretic response.
  
  
  BACKGROUND
  NCT00520806.
authors.affiliation: University of Groningen, Groningen, the Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Barry H
authors.initials: BH
authors.lastname: Greenberg
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.forename: Bruce
authors.initials: B
authors.lastname: Levin
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
authors.forename: Thomas
authors.initials: T
authors.lastname: Severin
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000208:Acute Disease; D000368:Aged; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005665:Furosemide / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010919:Placebos; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D010919:Placebos; D005665:Furosemide
keywords: Diuretic response; Heart failure; Renal function