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Substantial discrepancy between fluid and weight loss during acute decompensated heart failure treatment: Important lessons for research and clinical care.
Am J Med. 2015 Jan 13;
Authors: Testani JM, Brisco MA, Kociol RD, Jacoby D, Bellumkonda L, Parikh CR, Coca SG, Wilson Tang WH
Abstract
BACKGROUND: Net fluid and weight loss are ubiquitously employed to monitor diuretic response in acute decompensated heart failure research and patient care. However, the performance of these metrics has never been critically evaluated. The weight and volume of aqueous fluids such as urine should be nearly perfectly correlated and with very good agreement. As a result significant discrepancy between fluid and weight loss during the treatment of acute decompensated heart failure would indicate measurement error in one or both of the parameters.
METHODS: The correlation and agreement (Bland-Altman method) between diuretic-induced fluid/weight loss were examined in three acute decompensated heart failure trials and cohorts: 1) DOSE (n=254) 2) ESCAPE (n=348) the 3) Penn (n=486).
RESULTS: The correlation between fluid and weight loss was modest (DOSE r=0.55; ESCAPE r=0.48; Penn r=0.51; p<0.001 for all) and the 95% limits of agreement were wide (DOSE -7.9 to 6.4 Kg-L; ESCAPE -11.6 to 7.5 Kg-L; Penn -14.5 to 11.3 Kg-L). The median relative disagreement ranged from ± 47.0% to 63.5%. A bias toward greater fluid than weight loss was found across populations (-0.74 to -2.1 Kg-L p≤0.002). A consistent pattern of baseline characteristics or in-hospital treatment parameters that could identify patients at risk of discordant fluid and weight loss was not found.
CONCLUSIONS: Considerable discrepancy between fluid balance and weight loss is common in patients treated for acute decompensated heart failure. Awareness of the limitations inherent to these commonly used metrics and efforts to develop more reliable measures of diuresis are critical for both patient care and research in acute decompensated heart failure.
PMID: 25595470 [PubMed - as supplied by publisher]