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Loop Diuretic Efficiency: A Metric of Diuretic Responsiveness with Prognostic Importance in Acute Decompensated Heart Failure.
Circ Heart Fail. 2013 Dec 30;
Authors: Testani JM, Brisco MA, Turner JM, Spatz ES, Bellumkonda L, Parikh CR, Tang WH
Abstract
BACKGROUND: -Rather than the absolute dose of diuretic or urine output, the primary signal of interest when evaluating diuretic responsiveness is the efficiency with which the kidneys can produce urine after a given dose of diuretic. As a result, we hypothesized that a metric of diuretic efficiency (DE) would capture distinct prognostic information beyond that of raw fluid output or diuretic dose.
METHODS AND RESULTS: -We independently analyzed two cohorts: 1) consecutive admissions at the University of Pennsylvania (Penn) with a primary discharge diagnosis of HF (n=657) and 2) patients in the ESCAPE dataset (n=390). DE was estimated as the net fluid output produced per 40 mg of furosemide equivalents, then dichotomized into high vs. low DE based on the median value. There was only a moderate correlation between DE and both the IV diuretic dose and net fluid output (r(2) ≤ 0.26 for all comparisons), indicating that the diuretic efficiency was describing unique information. With the exception of metrics of renal function and pre-admission diuretic therapy, traditional baseline characteristics including right heart catheterization variables were not consistently associated with DE. Low DE was associated with worsened survival even after adjusting for in-hospital diuretic dose, fluid output, in addition to baseline characteristics (Penn HR=1.36, 95% CI 1.04-1.78, p=0.02; ESCAPE HR= 2.86, 95% CI 1.53-5.36, p=0.001.
CONCLUSIONS: -Although in need of validation in less selected populations, low diuretic efficiency during decongestive therapy portends poorer long-term outcomes above and beyond traditional prognostic factors in patients hospitalized with decompensated heart failure.
PMID: 24379278 [PubMed - as supplied by publisher]