Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy.
J Card Fail. 2012 Nov;18(11):837-44
Authors: Gupta A, Braunwald E, McNulty S, Felker GM, Gilbert EM, Alharethi R, Lee KL, Anstrom KJ, Redfield MM, Goldsmith SR, O'Connor CM, Bull DA, Stehlik J, Litwin SE
BACKGROUND: Obesity could attenuate diuretic effectiveness in treatment of acute decompensated heart failure (HF).
METHODS AND RESULTS: The DOSE trial randomized 308 subjects with acute HF to low- versus high-intensification intravenous diuretic therapy. We tested for statistical interactions between obesity and dosing strategy across clinical end points. After 72 hours of treatment, obese subjects (body mass index >30 kg/m(2); n = 173) had greater volume loss than nonobese subjects (n = 119) but similar improvements in dyspnea and freedom from congestion. Both groups had greater fluid loss with high-intensification treatment. Obese subjects had a higher incidence of worsening renal function (WRF) at 72 hours with low-intensification treatment, compared with nonobese subjects. In contrast, nonobese and obese subjects had similar incidence of WRF with high-intensification treatment. There were no differences between obese and nonobese subjects in time to discharge and 60-day freedom from death, emergency department visit, or rehospitalization.
CONCLUSIONS: The incidence of WRF was greater in obese than in nonobese subjects with low-intensification treatment. However, the frequency of WRF was equivalent in obese and nonobese subjects with high-intensification treatment. Additional studies are needed to assess whether obese patients with acute HF benefit from an initial high-intensification treatment strategy.
PMID: 23141856 [PubMed - indexed for MEDLINE]