Continuous versus intermittent administration of furosemide in acute decompensated heart failure: a systematic review and meta-analysis

Kuriyama, Akira; Urushidani, Seigo

doi:10.1007/s10741-018-9727-7

Cited by 22 publications

(14 citation statements)

References 47 publications

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“…Sixth, our study focused on PICU patients who received intermittent bolus of furosemide. Although adverse events did not differ between intermittent and continuous administration of furosemide, a previous study showed that a continuous infusion was associated with a potential increase in 24-h urine output ( 46 ). Our results cannot be applied to continuous furosemide administration.…”

Section: Discussionmentioning

confidence: 90%

Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children

Dai

Chen

et al. 2021

Front. Pediatr.

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Furosemide is commonly prescribed in critically ill patients to increase the urine output and prevent fluid overload (FO) and acute kidney injury (AKI), but not supported by conclusive evidence. There remain conflicting findings on whether furosemide associates with AKI and adverse outcomes. Information on the impact of furosemide on adverse outcomes in a general population of pediatric intensive care unit (PICU) is limited. The aim of the cohort study was to investigate the associations of furosemide with AKI and clinical outcomes in critically ill children.Study Design: We retrospectively reviewed a cohort of 456 critically ill children consecutively admitted to PICU from January to December 2016. The exposure of interest was the use of furosemide in the first week after admission. FO was defined as ≥5% of daily fluid accumulation, and mean FO was considered significant when mean daily fluid accumulation during the first week was ≥5%. The primary outcomes were AKI in the first week after admission and mortality during PICU stay. AKI diagnosis was based on Kidney Disease: Improving Global Outcomes criteria with both serum creatinine and urine output.Results: Furosemide exposure occurred in 43.4% of all patients (n = 456) and 49.3% of those who developed FO (n = 150) in the first week after admission. Patients who were exposed to furosemide had significantly less degree of mean daily fluid accumulation than those who were not (1.10 [−0.33 to 2.61%] vs. 2.00 [0.54–3.70%], P < 0.001). There was no difference in the occurrence of AKI between patients who did and did not receive furosemide (22 of 198 [11.1%] vs. 36 of 258 [14.0%], P = 0.397). The mortality rate was 15.4% (70 of 456), and death occurred more frequently among patients who received furosemide than among those who did not (21.7 vs. 10.5%, P = 0.002). Furosemide exposure was associated with increased odds for mortality in a multivariate logistic regression model adjusted for body weight, gender, illness severity assessed by PRISM III score, the presence of mean FO, and AKI stage [adjusted odds ratio (AOR) 1.95; 95%CI, 1.08–3.52; P = 0.026].Conclusion: Exposure to furosemide might be associated with increased risk for mortality, but not AKI, in critically ill children.

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Section: Discussionmentioning

confidence: 90%

Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children

Dai

Chen

et al. 2021

Front. Pediatr.

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“…Continuous infusion of furosemidecompared to intermittent administration-, is associated with a greater body weight reduction and potential increase in 24-h urine output. The limited available evidence suggests no difference in adverse events between both strategies [77].…”

Section: Is There a Safer Way To Use Diuretics: Bolus Versus Infusion?mentioning

confidence: 99%

Which is the best strategy for using diuretics in decompensated chronic heart failure?

Vincenzo¹,

Martina²,

Marco³

2019

Frontiers Drug Chemistry Clinical Res

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Heart failure is a common clinical syndrome with symptoms and signs caused by cardiac dysfunction with inability of the heart to supply the metabolic demands of peripheral tissues with the required amount of blood and oxygen. HF is a chronic condition that may worsen acutely. This condition, known as decompensated heart failure, presents with symptoms and signs related to congestion. Although diuretics are drugs of first choice to control fluid retention, diuretic therapy is still empirical and no conclusive data are available on how these drugs should be managed in decompensated heart failure.Here, we review the role of the different diuretics in decompensated heart failure and we illustrate the different strategies of diuretic therapy that have been proposed in literature.

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“…En este sentido, la infusión continua parecería ser una mejor opción que los bolos. Dos metaanálisis han encontrado beneficio en volumen urinario y pérdida de peso a favor de la infusión sin diferencia en efectos adversos 49,50 . El estudio DRAIN (no incluido en los metaanálisis previos) demostró que la infusión lograba mayor descongestión y menor fracaso en el tratamiento en pacientes con alto riesgo de resistencia a diuréticos (presión sistólica < 110 mmHg, sodio sérico < 130 meq/L, FEVI <30%) 51 .…”

Section: Tratamiento Agudounclassified

Síndrome cardiorrenal: clasificación, fisiopatología, diagnóstico y tratamiento. Una revisión de las publicaciones médicas

Chávez-Íñiguez

Sánchez-Villaseca

García-Macías

2021

ACM

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El síndrome cardiorrenal es una entidad compleja en la que la disfunción primaria cardíaca produce daño renal (tipos 1 y 2) y viceversa (tipos 3 y 4) y los episodios pueden ser agudos o crónicos o bien efecto de una enfermedad sistémica que afecta a ambos órganos (tipo 5). Hasta 49% de los pacientes con insuficiencia cardíaca muestra algún grado de disfunción renal, lo que aumenta de manera significativa la morbilidad y mortalidad. Su patogenia incluye diversos factores hemodinámicos, hormonales e inmunológicos que en la mayor parte de los casos producen sobrecarga hídrica, y cuyo diagnóstico y tratamiento son la base de su atención. En la actualidad, el diagnóstico clínico es insuficiente y se requieren marcadores bioquímicos, como péptidos natriuréticos, o el uso de ultrasonido pulmonar y cardíaco; estas herramientas, junto con la medición del sodio urinario, también permiten vigilar la efectividad terapéutica. De modo inicial se prefieren las medidas descongestivas con diuréticos de asa en infusión continua a dosis escalonadas para alcanzar una diuresis mínima de 3 L por día, con la posibilidad de agregar diuréticos ahorradores de potasio, tiazidas e inhibidores de la anhidrasa carbónica de modo secuencial para alcanzar el objetivo; como último recurso se recurre a la ultrafiltración en virtud de su mayor tasa de complicaciones. Por último, se debe indicar tratamiento con base en la evidencia para mejorar la calidad de vida, reducir la mortalidad y retrasar el deterioro de la función renal y cardíaca a largo plazo.

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Continuous versus intermittent administration of furosemide in acute decompensated heart failure: a systematic review and meta-analysis

Abstract: PROSPERO (CRD42017083878).

Cited by 22 publications

References 47 publications

Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children

Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children

Which is the best strategy for using diuretics in decompensated chronic heart failure?

Síndrome cardiorrenal: clasificación, fisiopatología, diagnóstico y tratamiento. Una revisión de las publicaciones médicas

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