Continuous versus intermittent use of furosemide in patients with heart failure and moderate chronic renal dysfunction

Abstract

Aims: There is paucity of clinical data comparing continuous infusion (CI) with bolus injection (BI) of intravenous loop diuretics in patients with acute decompensated heart failure (ADHF) and chronic renal dysfunction. This study aimed to compare the efficacy and safety of CI versus BI intravenous furosemide administration in patients with ADHF and moderate chronic renal insufficiency.

Methods and results: Acute decompensated heart failure and moderate chronic renal insufficiency [with estimated glomerular filtration rate (eGFR) 15.0-44.9 mL/min/1.73 m² ] were randomized to start intravenous furosemide by BI or by a 6 h CI. End points included freedom from congestion at 72 h, the degree of dyspnoea assessed using the 0-10 Borg's category ratio scale, net daily urine output, weight loss during the study, length of hospital stay, total urinary sodium excretion, and development of acute kidney injury or electrolyte disturbance. After 72 h of treatment, the rate of the primary endpoint of freedom from congestion in the CI group was significantly higher than that in the BI group (69.05% vs. 43.59%, P = 0.02). The modified Borg scale indicated patients in the CI group had lower dyspnoea score than those in the BI group at 48 h (4.29 ± 1.23 vs. 5.97 ± 1.56; P = 0.02) and 72 h (1.15 ± 0.35 vs. 2.66 ± 0.83; P = 0.003). There were other significant differences favouring the CI group with regard to net urine output at 72 h (5145.98 ± 621.37 mL vs. 3755.95 ± 456.93 mL; P = 0.007), the mean body weight loss (4.72 ± 1.01 kg vs. 3.53 ± 0.73 kg; P = 0.02) and the total urinary sodium excretion (385.05 ± 38.15 vs. 320.33 ± 37.67; P = 0.02). The length of hospitalization in the CI group was significantly shorter than that in the BI group (10.36 ± 4.20 days vs. 15.68 ± 6.15 days; P = 0.02). No significant differences were observed between groups in the frequency of acute kidney injury, tinnitus, electrolyte disturbance or mortality.

Conclusions: Continuous intravenous infusion of furosemide resulted in significantly greater diuresis than bolus administration of an equal dose in patients with moderate chronic renal insufficiency and ADHF, while no differences emerged in terms of side effects or mortality.

Keywords: Chronic renal insufficiency; Continuous infusion; Furosemide; Heart failure.

Figure 1

Flow chart of the participants through the study. CI, continuous infusion; BI, bolus injection.

Figure 2

Patients' subjective symptoms of dyspnoea using the modified Borg scale. CI, continuous infusion; BI, bolus injection.

Figure 3

Change in weight between groups. CI, continuous infusion; BI, bolus injection.

Figure 4

Cumulative net urinary output between groups. CI, continuous infusion; BI, bolus injection.

Figure 5

Cumulative urinary sodium excretion between groups. CI, continuous infusion; BI, bolus injection.

Figure 6

Cumulative urinary potassium excretion between groups. CI, continuous infusion; BI, bolus injection.