title: Renal function on admission modifies prognostic impact of diuretics in acute heart failure: a propensity score matched and interaction analysis.
abstract: Although intravenous diuretics have been mainstay drugs in patients with acute heart failure (AHF), they have been suggested to have some deleterious effects on prognosis. We postulated that renal function may modify their deleterious effects in AHF patients. The study population consisted of 1094 AHF patients from three hospitals. Renal dysfunction (RD) was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2on admission, and the cohort was divided into a high-dose furosemide (≥100 mg/48 h) and low-dose furosemide group according to the amount of intravenous furosemide used within 48 h from admission. In the whole cohort, in-hospital mortality rate was higher in the high-dose furosemide group than the low-dose furosemide group (12.5 vs. 6.6 %, respectively, P = 0.001). However, this difference in the in-hospital mortality rates was significant only in the RD subgroup (15.6 vs. 7.0 %, respectively, P < 0.001), and not in the non-RD subgroup (2.5 vs. 5.9 %, respectively, P = 0.384). Propensity score-matched analysis was performed to evaluate the impact of high-dose furosemide on prognosis. After propensity score matching, high-dose furosemide was not associated with in-hospital mortality (OR 1.25, 95 % CI 0.73-2.16, P = 0.408). However, there was a qualitative difference in OR for in-hospital mortality between AHF with RD (OR 1.77, 95 % CI 0.96-3.28, P = 0.068) and without RD (OR 0.23, 95 % CI 0.05-1.10, P = 0.064), and there was a significant interaction between eGFR and prognostic impact of high-dose furosemide (P for OR interaction = 0.013). An inverse relationship was observed between eGFR and OR for in-hospital death in the group treated with high-dose furosemide (decreasing OR with better eGFR). The deleterious effect of diuretics was significantly modified with renal function in AHF. This association may be one reason for poorer prognosis of AHF patients complicated with renal impairment.
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929, Higashi-cho, Kamogawa, Chiba, Japan. yuya8950@gmail.com.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Matsue
authors.affiliation: Trauma and Acute Critical Care Medical Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiraishi
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kagiyama
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Kume
authors.affiliation: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okura
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929, Higashi-cho, Kamogawa, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929, Higashi-cho, Kamogawa, Chiba, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumura
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929, Higashi-cho, Kamogawa, Chiba, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hashimoto
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000009:adverse effects; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010343:Patient Admission; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D005665:Furosemide
keywords: Acute heart failure; Diuretics; Prognosis; Renal function