Abstract 14306: Patients With Stable Systolic Heart Failure and Renal Insufficiency: The Effects of Furosemide Dose Reduction on Renal Function and Clinical Status
Background: Furosemide (F) and other loop diuretics are mainstays in heart failure (HF) management. While essential in achieving euvolemia, increasing data suggests that excessive F may impair renal blood flow and function, which are negative prognostic markers in HF. Our objective was to determine the effects of reducing F doses on renal function in stable HF patients with and without renal insufficiency.
Hypothesis: We hypothesized that F reduction would result in improved renal function among stable HF patients with baseline renal insufficiency.
Methods: Stable NYHA Class 2/3 stable systolic (EF<40%) HF subjects with a glomerular filtration rate (GFR) of ≤60 ml/min/1.72m2 (reduced renal function; n=19) and ≥60 ml/min/1.72m2 (normal renal function; n=13). Participants must have been on stable doses of F for 3 months. Baseline iothalamate GFR, PAH determination of effective renal plasma flow (RPF), Minnesota Living with HF Quality (MLHFQ) Score, and 6 min walk were assessed. Participants then decreased their F dose by 50% for 3 weeks and titrated F dose as needed based on a pre formulated algorithm. Following 3 weeks of reduced F, subjects underwent repeat assessment of GFR, RPF, MLHFQ Score, and 6 min walk. At the study conclusion, F dose was returned to the pre-study dose.
Results: Baseline GFR was 42±13 ml/min/1.72 m2 and 78±11 ml/min/1.72 m2 and the mean daily F was 38±18 and 36±18 mg in the reduced and normal renal function cohorts respectively. During the 3 weeks of reduced F dosing the mean daily dose was 21±11 and 20±13 mg in reduced and normal renal function cohorts respectively. No adverse effects were noted. Following 3 weeks of reduced F, GFR increased to 50±16 ml/min/1.72 m2 (p<0.01 vs baseline) in the reduced renal function cohort with a trend for RPF to increase. GFR was not changed in the normal renal function cohort. Reduction in F did not adversely impact 6 minute walk distance or the MLHF Q Score in either cohort.
Discussion Among NYHA class 2/3 stable HF subjects with impaired renal function, a reduction in daily F is safe and associated with improved renal function. Lowered F dosing had no impact on GFR in the normal renal function cohort. Further studies are warranted to determine if these physiological findings would translate into improved clinical outcomes.
- © 2013 by American Heart Association, Inc.