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Randomized Controlled Trial
. 2017 Nov;4(4):479-486.
doi: 10.1002/ehf2.12226. Epub 2017 Oct 4.

Rationale and study design of intravenous loop diuretic administration in acute heart failure: DIUR-AHF

Alberto Palazzuoli  1 , Gaetano Ruocco  1 , Giorgio Vescovo  2 , Roberto Valle  3 , Salvatore Di Somma  4 , Ranuccio Nuti  1
Affiliations
Randomized Controlled Trial

Rationale and study design of intravenous loop diuretic administration in acute heart failure: DIUR-AHF

Alberto Palazzuoli et al. ESC Heart Fail. 2017 Nov.

Abstract

Aims: Although loop diuretics are the most commonly used drugs in acute heart failure (AHF) treatment, their short-term and long-term effects are relatively unknown. The significance of worsening renal function occurrence during intravenous treatment is not clear enough. This trial aims to clarify all these features and contemplate whether continuous infusion is better than an intermittent strategy in terms of decongestion efficacy, diuretic efficiency, renal function, and long-term prognosis.

Methods and results: This is a prospective, multicentre, randomized study that compares continuous infusion to intermittent infusion and a low vs. high diuretic dose of furosemide in patients with a diagnosis of acute heart failure, BNP ≥ 100 pg/mL, and specific chest X-ray signs. Randomization criteria have been established at a 1:1 ratio using a computer-generated scheme of either twice-daily bolus injection or continuous infusion for a time period ranging from 72 to 120 h. The initial dose will be 80 mg/day of intravenous furosemide and, in the case of poor response, will be doubled using an escalation algorithm. A high diuretic dose is defined as a furosemide daily amount >120 mg/day respectively.

Conclusions: Continuous and high dose groups could reveal a more intensive diuresis and a greater decongestion with respect to intermittent and low dose groups; high dose and poor loop diuretic efficiency should be related to increased diuretic resistance, renal dysfunction occurrence, and greater congestion status. Poor diuretic response will be associated with less decongestion and an adverse prognosis.

Trial registration: ClinicalTrials.gov NCT02638142.

Keywords: Acute heart failure; Diuretic efficiency; Loop diuretics; Outcome; Renal function; Treatment.

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Figures

Figure 1
Figure 1
Study design describing timing assessment before and after treatment and follow‐up evaluation.
Figure 2
Figure 2
Scheme of diuretics dose administration by escalation algorithm based on diuretic response.
See this image and copyright information in PMC

References

    1. Ahmed A, Young JB, Love TE, Levesque R, Pitt B. A propensity matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure. Int J Cardiol 2008; 125: 246–253. - PMC - PubMed
    1. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O'Connor CM. Diuretic strategies in acute decompensated heart failure. N Engl J Med 2011; 364: 797–805. - PMC - PubMed
    1. Salvador DR, Rey NR, Ramos GC, Punzalan FE. Continuous infusion versus bolus injection of loop diuretics in congestive heart failure. Cochrane Database Syst Rev 2005; 3: CD003178. - PMC - PubMed
    1. Ter Maaten JM, Dunning AM, Valente MA, Damman K, Ezekowitz JA, Califf RM, Starling RC, van der Meer P, O'Connor CM, Schulte PJ, Testani JM, Hernandez AF, Tang WH, Voors AA. Diuretic response in acute heart failure—an analysis from ASCEND‐HF. Am Heart J 2015; 170: 313–321. - PubMed
    1. Voors AA, Davison BA, Teerlink JR, Felker GM, Cotter G, Filippatos G, Greenberg BH, Pang PS, Levin B, Hua TA, Severin T, Ponikowski P, Metra M. RELAX‐AHF Investigators. Diuretic response in patients with acute decompensated heart failure: characteristics and clinical outcome—an analysis from RELAX‐AHF. Eur J Heart Fail 2014; 16: 1230–1240. - PMC - PubMed

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