title: Diuretic response in acute heart failure-an analysis from ASCEND-HF.
abstract: BACKGROUND
  Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF.
  
  
  METHODS
  Diuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent.
  
  
  RESULTS
  Mean diuretic response was -0.42 kg/40 mg of furosemide (interquartile range -1.0, -0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response (P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide.
  
  
  CONCLUSIONS
  Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response.
authors: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors: Jozine M
authors: JM
authors: ter Maaten
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Allison M
authors: AM
authors: Dunning
authors: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors: Mattia A E
authors: MA
authors: Valente
authors: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors: Kevin
authors: K
authors: Damman
authors: Mazankowski Alberta Heart Institute, Edmonton, Canada.
authors: Justin A
authors: JA
authors: Ezekowitz
authors: Duke Translational Medicine Institute, Durham, NC.
authors: Robert M
authors: RM
authors: Califf
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Randall C
authors: RC
authors: Starling
authors: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
authors: Peter
authors: P
authors: van der Meer
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Christopher M
authors: CM
authors: O'Connor
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Phillip J
authors: PJ
authors: Schulte
authors: Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT.
authors: Jeffrey M
authors: JM
authors: Testani
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Adrian F
authors: AF
authors: Hernandez
authors: Cleveland Clinic Foundation, Cleveland, OH.
authors: W H Wilson
authors: WH
authors: Tang
authors: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: a.a.voors@umcg.nl.
authors: Adriaan A
authors: AA
authors: Voors
mesh_terms: D000208:Acute Disease; D000368:Aged; D018450:Disease Progression; D004232:Diuretics / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D004232:Diuretics; D005665:Furosemide