Heart failure & cardiomyopathiesCohort study
The Blunted Loop Diuretic Response in Acute Heart Failure is Driven by Reduced Tubular Responsiveness Rather than Insufficient Tubular Delivery. The Role of Furosemide Urine Excretion on Diuretic and Natriuretic Response in Acute Heart Failure
- Prospective observational study
Authors' conclusion
Patients naïve to furosemide have significantly better diuresis and natriuresis when compared to chronic furosemide users. The blunted diuretic response in patients with chronic loop diuretic exposure is driven by decreased tubular responsiveness rather than insufficient furosemide tubular delivery.
Study context
- Population
- Patients with acute HF receiving a standardized, body-weight-based furosemide dose
- Participants
- 50 patients
- Exposure
- Furosemide naïve vs chronic furosemide users
- Furosemide naïven = 28
- Chronic furosemide usersn = 22reference
Main finding
As reported in the abstract
Urine furosemide delivery (eGFR-adjusted) and tubular response (urine volume per 1 μg/ml urine furosemide at 2 h)
| Group | Urine furosemide delivery | Urine volume per 1 μg/ml urine furosemide at 2 h |
|---|---|---|
| Furosemide naïve | 28.02 [21.03-35.89] mg | 148.6 ± 136.1 ml |
| Chronic furosemide users | 29.70 [18.19-34.71] mg | 50.6 ± 56.1 ml |
- Furosemide naïve vs Chronic furosemide users: P = 0.87 — urine furosemide delivery, after accounting for eGFR
- Furosemide naïve vs Chronic furosemide users: P = 0.005 — urine volume per 1 μg/ml urine furosemide at 2 h
- Higher urine volumes and natriuresis in furosemide naïve vs chronic users at all timepoints
- all p < 0.05
Observational data: associations, not effects.
Further findings
Urine furosemide delivery (accounting for eGFR differences) · similar
P = 0.87
Tubular response: urine volume per 1 μg/ml urine furosemide · 2 h
P = 0.005
Original publication
The Blunted Loop Diuretic Response in Acute Heart Failure is Driven by Reduced Tubular Responsiveness Rather than Insufficient Tubular Delivery. The Role of Furosemide Urine Excretion on Diuretic and Natriuretic Response in Acute Heart Failure. Eur J Heart Fail. Published 1 May 2023. doi:10.1002/ejhf.2852
Summarised from the published abstract; every number is checked against it