Prediction and measurement of diuretic responsiveness after oral administration of furosemide to healthy dogs and dogs with congestive heart failure

Abstract

Background: In human patients, cumulative urine volume (uVol) and urine sodium (uNa) can be predicted using spot urine samples and these quantitative measures help detect low diuretic responsiveness (LDR). Hypothesis/objectives: Formulas using spot urine samples predict cumulative uVol and uNa output after oral administration of furosemide to dogs. Animals: Eight healthy dogs, 6 dogs with congestive heart failure (CHF). Methods: Prospective interventional study. Spot urine samples at 180 and 270 minutes after furosemide (3 mg/kg PO) were used to predict cumulative uVol and uNa output over 7 hours. Differentiation of dogs fulfilling predefined criteria for LDR was examined using receiver operating characteristic (ROC) curves.

Toward quantification of loop diuretic responsiveness for congestive heart failure

“…In the healthy dog, IV furosemide infusion results in urine volume and uNa that are closely correlated, 40 but in dogs with CHF, diuresis and natriuresis, although related, are not interchangeable metrics of responsiveness. 43 Previous studies in humans and dogs measured uNa at specific time points after furosemide dosing and lend support to the concept of uNa-based measures. 8,43,[50][51][52][53] One study in dogs with compensated CHF showed that uNa measured 3 hours after PO administration of furosemide (3 mg/kg) was significantly and highly correlated to the total amount of urinary Na excreted in response to this dose.…”

“…Previous studies in humans and dogs measured uNa at specific time points after furosemide dosing and lend support to the concept of uNa‐based measures 8,43,50‐53 . One study in dogs with compensated CHF showed that uNa measured 3 hours after PO administration of furosemide (3 mg/kg) was significantly and highly correlated to the total amount of urinary Na excreted in response to this dose 43 .…”

“…Urine volume alone cannot differentiate between urine with high or low Na content, which as previously mentioned, is an important determinant of long‐term outcome. In the healthy dog, IV furosemide infusion results in urine volume and uNa that are closely correlated, 40 but in dogs with CHF, diuresis and natriuresis, although related, are not interchangeable metrics of responsiveness 43 …”

“…34 Recently, quantitative metrics of diuretic resistance that are based on uNa and urine volume, have been proposed in humans and dogs (Table 2). 34,38,39,43…”

Management of Chronic Congestive Heart Failure Caused by Myxomatous Mitral Valve Disease in Dogs: A Narrative Review from 1970 to 2020

“…In these papers, the diuretic has been administered over a dose range of 0.13 mg/kg/day to 0.5 mg/kg/day, and spironolactone (an aldosterone receptor antagonist) has been administered at dosages from 0.49 mg/kg once daily to 2 mg/kg once daily. These drugs are very useful in the therapy of CHF secondary to MMVD in dogs [ 362 , 363 , 364 , 365 , 366 , 367 , 368 , 369 ].…”