Abstract 16824: Even Standard Dose of Furosemide is Associated with Chronic Kidney Injury in Patients with Chronic Heart Failure
Background : High dose of loop diuretics has been associated with poor outcome in heart failure patients. However, it remains to be fully clarified whether even standard dose of diuretics would be related to worsening renal function in chronic heart failure (CHF) patients. We investigated the impact of loop diuretic dose on renal dysfunction in CHF patients, relating to chronic kidney disease (CKD).
Method : In this prospective study, we enrolled 158 CHF outpatients (NYHA class: 2.0±0.6) with radionuclide LVEF<40% (30±8%). Patients were divided into two groups according to the dose of furosemide, the standard dose group (SD): ≧40 - 80mg/d (50±16mg/d; n=76) and low dose group (LD) <40mg/d (11±10mg/d; n=82). The measurement of serum creatinine (sCr) level was measured at entry, and repeated every at least 6 month after the entry, and chronic kidney injury (CKI) was defined as an increase of more than 0.3mg/dl in baseline sCr value.
Results : At the entry, 75 of 158 patients had CKD (estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m2). During the follow up period of 5.5±3.9 years, CKI was observed in 81 (48 in SD group and 33 in LD group). There were no significant differences in baseline clinical characteristics such as age, gender, LVEF or eGFR between SD and LD groups in CKD or non-CKD groups. In CKD group, CKI was significantly more frequently observed in SD than LD group (70% vs 43%, p=0.004, HR 2.4 (95% CI 1.3-4.4). In non-CKD group, SD showed the significantly higher risk of CKI than LD (56% vs 38%, p=0.01, HR 2.2 (95% CI 1.1-4.2). Furthermore, cardiac event, including hospitalization of worsening heart failure and sudden cardiac death, was higher in SD than LD group, both in CKD (63% vs 29%, p=0.03, HR 2.2 (95% CI 1.1-4.7) and in non-CKD (53% vs 34%, p=0.002, HR 2.9 (95% CI 1.5-5.9)
Conclusion : Even standard dose of furosemide is associated with chronic kidney injury and cardiac event in patients with mild to moderate CHF, irrespective of the presence of CKD.
- © 2012 by American Heart Association, Inc.