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 m 2 ] 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.

Clinical Effect of Mudan Granule on Peripheral Neuritis Caused by Chronic Renal Insufficiency

“…Exclusion criteria are as follows: (1) neuropathy caused by other causes, containing cervical and lumbar vertebra disease, cerebral infarction, severe arteriovenous vascular disease, and neurotoxicity caused by drugs and chemicals; (2) severe cardiac, liver and renal dysfunction [ 8 ]; (3) patients with malignant tumors; (4) those who cannot cooperate with clinical trials (patients with incomplete data); (5) those with increased complexity after comprehensive evaluation, such as unstable living environment and frequent changes in working environment; (6) patients with mental illness; (7) those who participated in clinical trials of other drugs in recent 1 month; and (8) those who had a history of alcoholism, psychotropic drugs, and drug dependence in the past 3 years.…”

Comparison of Different Furosemide Regimens in the Treatment of Acute Heart Failure: A Meta-Analysis

“…In total, 3 studies [ 10 , 11 , 13 ] with 230 AHF patients reported 72-hour urine volume. There was significant heterogeneity among the studies ( I 2 = 89%, P = 0.0002, Figure 5 ), which were analyzed by the random effects model.…”

“…Meta-analysis of 221 AHF patients from 3 studies [ 8 , 9 , 13 ] using the random effects model ( I 2 = 71%, P = 0.03, Figure 6 ) showed that continuous administration of furosemide was not associated with significantly decreased BNP levels (pg/mL) as compared with the furosemide intermittent injection (MD = 86.97, 95% CI (-117.31~291.24), P = 0.40) ( Figure 6 ). Egger's test showed no publication bias among the literature ( P > 0.05).…”

“…The included 10 studies compared the continuous intravenous injection of furosemide with furosemide intermittent injection in hospitalized AHF patients [8][9][10][11][12][13][14][15][16][17]. Studies were performed in Asia, Europe, North America, and Africa, with 3 from the United States [10][11][12], 2 from Italy [8,9], and 1 from China [13], Turkey [14], India [15], Israel [16], and Egypt [17], respectively. The largest sample, with a total of 308 cases, was reported from the United States [11] (Table 1).…”

“…A total of 7 studies [8][9][10][11][12][13][14] with 655 AHF patients reported overall weight loss during hospitalization. The fixed effects model was used for analysis, given the absence of interstudy heterogeneity (I 2 = 0%, P = 0:90, Figure 2).…”