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. 2025 Jun 25;17(13):2105.
doi: 10.3390/nu17132105.

Loop Diuretic Dose and Nutritional Status of Patients with Heart Failure with Reduced Ejection Fraction

Filip Sawczak  1 , Aleksandra Soloch  1 , Maria Cierzniak  1 , Alicja Szubarga  1 , Kamila Kurkiewicz-Sawczak  2 , Agata Kukfisz  3 , Magdalena Szczechla  1 , Helena Krysztofiak  1 , Magdalena Dudek  1 , Ewa Straburzyńska-Migaj  1 , Marta Kałużna-Oleksy  1
Affiliations

Loop Diuretic Dose and Nutritional Status of Patients with Heart Failure with Reduced Ejection Fraction

Filip Sawczak et al. Nutrients. .

Abstract

Background/Objectives: Loop diuretics are among the most commonly used drugs in patients with heart failure with reduced ejection fraction (HFrEF). Higher doses of these diuretics are associated with poorer clinical status and may contribute to malnutrition. The study aims to assess the relationship between the use of high-dose loop diuretics and nutritional status in patients with HFrEF. Methods: The study included 353 hospitalized patients with HFrEF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Geriatric Nutritional Index (GNRI), and the CONtrolling NUTritional status (CONUT). Patients were divided into three groups according to the daily dose of loop diuretics (defined as furosemide equivalent = 1 × furosemide dose and 2 × torsemide dose): low dose (LD), 40 mg/day or no treatment; medium dose (MD), 41-160 mg/day; or high dose (HD), >160 mg/day. Results: Of the evaluated patients, the mean MNA score was 23.31 ± 2.93 points, and 49.8% were at risk of malnutrition or malnourished. According to the MNA, patients in HD and MD groups had worse nutritional status than the LD group, similarly according to the GNRI. For CONUT, the differences were significant between all groups: nutritional status was the worst in the HD group, intermediate in the MD group, and the best in the LD group. Conclusions: The intake of loop diuretics, especially in high doses, correlates with an elevated risk of malnutrition in patients with HFrEF independently of sex, age, NYHA class, and left ventricular ejection fraction.

Keywords: BMI; CONUT; GNRI; MNA; furosemide; heart failure; malnutrition; nutrition; nutritional risk; torsemide.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart visualizing the enrollment process and analysis. CONUT—Controlling Nutritional Status (score); GNRI—Geriatric Nutritional Risk Index; HF—heart failure; MNA—Mini Nutritional Assessment.
Figure 2
Figure 2
Comparison of nutritional status depending on loop diuretic dose in whole group (n = 353). CONUT—Controlling Nutritional Status (score); GNRI—Geriatric Nutritional Risk Index; MNA—Mini Nutritional Assessment.
Figure 3
Figure 3
Comparison of nutritional status depending on loop diuretic dose in groups matched with propensity score (n = 165). CONUT—Controlling Nutritional Status (score); GNRI—Geriatric Nutritional Risk Index; MNA—Mini Nutritional Assessment.
See this image and copyright information in PMC

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