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. 2021 Jan;26(1):127-136.
doi: 10.1007/s10741-020-10003-7.

Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials

Peter Samuel Eid  1   2 , Doaa Alaa Ibrahim  1   2 , Ahmad Helmy Zayan  2   3 , Manal Mahmoud Abd Elrahman  1   2 , Mostafa Ahmed Abdo Shehata  2   4 , Hend Kandil  2   5 , Mahmoud Ahmed Abouibrahim  2   6 , Luc Minh Duy  2   7 , Ashraf Shinkar  2   8 , Muhammed Khaled Elfaituri  2   9 , Le Huu Nhat Minh  2   10 , Mostafa Mahmoud Fahmy  2   11 , Dao Ngoc Hien Tam  2   12 , Nguyen Lam Vuong  2   10 , Jaffer Shah  2   13 , Van Buu Dan Do  14 , Kenji Hirayama  15 , Nguyen Tien Huy  16
Affiliations

Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials

Peter Samuel Eid et al. Heart Fail Rev. 2021 Jan.

Abstract

Diuretics have an essential role in the management of heart failure (HF). However, each drug has its own benefit and side effect. Side effects include fluid, electrolyte abnormalities, and acid-base disturbance. These adverse effects of diuretics predispose patients to serious cardiac arrhythmias and may increase the risk of arrhythmic mortality. Herein, we aim to summarize the relative efficacy and safety of all available diuretics used in the treatment of patients with HF. In June 2017, a systematic electronic database search was conducted in nine databases. All randomized controlled trials (RCTs) comparing the different diuretics used in HF were included for meta-analysis. The protocol was registered in Prospero with CRD42018084819. Among the included 54 studies (10,740 patients), 34 RCTs were eligible for quantitative network meta-analysis (NMA) and traditional meta-analysis while the other 20 studies were qualitatively analyzed. Our results showed that azosemide and torasemide caused a significant reduction in brain natriuretic peptide (BNP) level. Torasemide also caused a significant decrease in collagen volume fraction (CVF) and edema. No significant difference between the agents concerning glomerular filtration rate (GFR), water extraction, and sodium excretion was demonstrated. Regarding side effects, no significant difference among diuretics was observed in terms of hospital readmission and mortality rates. Diuretics are the main treatment of hypervolemia in HF patients. The choice of appropriate diuretic is essential for successful management and is mainly guided by patient clinical situations and the presence of other co-morbidities.

Keywords: Diuretics; Furosemide; Heart dysfunction; Heart failure; Myocardial failure.

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