title: Diuretic Response: Clinical and Hemodynamic Predictors and Relation to Clinical Outcome.
abstract: OBJECTIVE
  The aims of this work were to investigate the clinical and hemodynamic profile underlying the response to loop diuretics in acute decompensated heart failure (ADHF), and to compare the relative usefulness of measures of diuretic resistance for predicting mortality.
  
  
  RESULTS
  We studied 475 patients with ADHF, of whom 241 underwent right heart catheterization. Linear regression models were used to identify factors that affected urine output. Loop diuretics response was estimated as (1) net fluid loss per 40 mg furosemide equivalents and (2) urine output produced per 40 mg furosemide equivalents. In a multivariable regression model, key independent predictors of urine output included diuretic dose (partial r = 0.44), baseline renal function (partial r = 0.38), systolic blood pressure (partial r = 0.26), and fluid intake (partial r = 0.31; all P < .0001). Among hemodynamic variables, elevated right atrial pressure was associated with greater urine output (partial r = 0.19; P = .002). The partial correlation attributable to diuretic dose (partial R2 = 0.19) accounted for approximately one-half of the variance in urine output explained by the model (model R2 = 0.40).Cox regression models demonstrated inverse relationships between quartiles of net fluid loss (P = .004) and quartiles of urine output (P = .04) per 40 mg furosemide and 6-month mortality. When comparing nested models, the model based on net fluid loss was better than the model based on urine output for the prediction of mortality (χ2 = 8.1; 3 df; P = .04).
  
  
  CONCLUSIONS
  In patients with ADHF, beyond diuretic dose, other parameters including renal function, hemodynamic status, the degree of volume overload, and fluids intake also affect urine output. Measures of loop diuretic response are associated with short-term mortality.
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. Electronic address: daronson@tx.technion.ac.il.
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.affiliation: Division of Cardiovascular Disease, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Burger
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000652:urine; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors
keywords: Acute heart failure; Diuresis; central venous pressure; congestion