Abstract 11317: Plasma Renin Activity on Admission Predicts Diuretic Resistance and Poor Outcomes in Acute Decompensated Heart Failure: An Ancillary Study of the Diuretic Optimization Strategies Evaluation Trial
Background: Relief of volume overload is a primary goal in acute decompensated heart failure (ADHF) but response to diuretics is highly variable. Identification of patients at risk for diuretic resistance may allow early use of higher diuretic doses or more advanced adjuvant ADHF therapies. We hypothesized that increased plasma renin activity (PRA) may reflect sodium avidity and HF severity and thus predict diuretic resistance and worse outcomes in ADHF. The Diuretic Optimization Strategies Evaluation (DOSE) Trial investigated diuretic intensification and administration mode strategies in ADHF and collected data on diuretic response.
Methods: In ADHF patients enrolled in DOSE, PRA at randomization (<24 hrs after admission), cumulative weight loss at 48 and 72 hours, length of stay (LOS) and 60 day composite outcome (death, HF rehospitalization or emergency department visit for HF) were assessed.
Results: Of the 308 patients enrolled in DOSE, 279 had admission PRA measured. Increasing quartiles of log PRA were associated with higher administered diuretic dose (Figure 1 A) but patients in the highest PRA quartile (>15.8 ng/ml/hr) had less weight loss (Figure 1 B) despite similar evidence of volume overload (JVP elevation, NYHA class, NT-proBNP) at admission. Compared to patients with lower PRA, those in the highest PRA quartile experienced longer LOS (9.9 ± 8.6 vs. 6.9 ± 6.9 days, p=0.006) and higher rates of adverse outcomes (Figure 2) even after adjusting for admission blood pressure (p=0.015, HR (CI): 1.62 (1.10-2.38)).
Conclusion: High PRA on admission is predictive of diuretic resistance, prolonged hospitalization and worse outcomes in ADHF.
- © 2011 by American Heart Association, Inc.