A diuretic is said to be any drug that could lift up the rate of urination and thus offer a means of forced diuresis. The first trial to examine diuretics utilized regularly in hospitalized heart failure patients seems to exhibit that present administration practices are believed to be uniformly effectual, and higher doses appear to provide improved outcomes with negligible danger to renal function. At least this is what a study from Duke University Medical Center alleges.
Acute decompensated heart failure (ADHF) is supposedly responsible for over one million hospitalizations in the US every year, which could lead to six million hospital days and approximately costs $12 billion yearly.
Michael Felker, MD, a Duke cardiologist who presented the findings from the Diuretic Optimization Strategies Evaluation (DOSE) Study, the first trial completed by the NHLBI Heart Failure Clinical Research Network, commented, “This study addresses a lot of questions about the best way to administer and dose intravenous loop diuretics.”
The expert added, “Now we know definitively: it doesn’t matter whether loop diuretics are given intermittently or in continuous infusions. And, the study gives us more understanding about the trade-offs involved when choosing which dose to use.”
Loop IV diuretics are apparently utilized in around 90 percent of these cases, and the most general is thought to be furosemide, the drug studied in the trial. It seems to alleviate symptoms of congestion by augmenting urine input.
Felker explained, “Even though furosemide is good at getting rid of fluid and making patients feel better, there were concerns about giving the drug in high doses and its impact on renal function. The real aim of the study was to find out which method of administering furosemide maximized symptom relief while minimizing the risk of worsening renal function.”
This study recruited around 308 patients at nine regional clinical centers, who were randomized in a double-blind study to four diverse treatment groups. Patients were either given a high dose i.e. 2.5x their daily chronic oral furosemide dose given IV or low dose which is 1x their daily chronic oral furosemide dose given IV, which was administered either every 12 hours by means of IV bolus or using continuous infusion.
Felker remarked, “Our study showed no difference in efficacy or safety between intermittent IV boluses or continuous infusion. It’s really physician preference.”
Felker added, “There was a trend toward better symptom relief with high dose compared to low dose. There was a greater decrease in body weight in high dose, greater volume loss, and a great drop in biomarkers of volume overload. These trends suggest high dose may be a preferable approach. The high dose was also associated with mild increases in creatinine levels, a blood test used to measure kidney function, but it seemed to be transient. Transient worsening of renal function may be a small price to pay for trends toward better symptomatic improvement with the high dose.”
A bigger trial may be required to corroborate whether the advantages of the high dose may really offset any threats to renal function.
The findings were presented at the American College of Cardiology meeting.