title: Different diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance.
abstract: BACKGROUND
  The question regarding the correct balance between optimal loop diuretic dose administration and best modality is under debate as well as the exact relation existing between congestion and renal dysfunction. We sought to evaluate the effects of different diuretic modalities (low [LD] versus high dose [HD]) and dose administration on decongestion, Worsening renal function (WRF) and outcome.
  
  
  METHODS
  We retrospectively analyzed data of DIUR-HF study matching for LD vs HD (cut off 125mg/day), and diuretic efficiency (DE) (weight loss/40mg daily of furosemide). We also evaluated WRF rate (creatinine increase during hospitalization ≥0.3mg/dl or estimated glomerular filtration rate (eGFR) reduction ≥25%) together with decongestion.
  
  
  RESULTS
  HD patients (n.55) were older, more frequently affected by diabetes and chronic kidney disease (CKD) and demonstrated higher rate of inhospital WRF (65% vs 29% p=0.001) and 180-days adverse events (70% vs 23% p<0.001) respect to LD patients (n.41). Patients with low DE showed a higher 180days adverse events rate than higher DE patients (p=0.02). Univariate and multivariable analysis suggests a significant relationship between adverse events and low DE (patients with DE under median value) (U-HR=2.59 [1.44-4.64]; p=0.001. M-HR=3.16 [1.55-6.46]; p=0.002); continuous administration (HR=3.12 [1.65-5.91]; p<0.001) and WRF (HR=5.30 [2.79-10.09]; p<0.001) were also related with adverse events.
  
  
  CONCLUSIONS
  HD and poor DE are two conditions associated with adverse outcome. Both situations are the consequence of previous detrimental clinical status and they appear strictly related to WRF occurrence.
authors.affiliation: Department of Internal Medicine, Cardiovascular Diseases Unit, S Maria alle Scotte Hospital, University of Siena, Italy. Electronic address: palazzuoli2@unisi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.affiliation: Department of Internal Medicine, Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
authors.affiliation: Department of Internal Medicine, Cardiovascular Diseases Unit, S Maria alle Scotte Hospital, University of Siena, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ruocco
authors.affiliation: Department of Internal Medicine, Cardiovascular Diseases Unit, S Maria alle Scotte Hospital, University of Siena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrini
authors.affiliation: Nephrology Dialysis & Transplantation, International Renal Research Institute (IRRIV), St. Bortolo Hospital, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.affiliation: Department of Internal Medicine, Cardiovascular Diseases Unit, S Maria alle Scotte Hospital, University of Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D005665:Furosemide
keywords: Acute heart failure; Diuretic efficiency; Loop diuretics; Outcome; Worsening renal function