Abstract 19591: Long-term Renal Function Following Worsening Renal Function Precipitated by Aggressive Diuresis: Insights From the DOSE Trial Limited Dataset
Background: Worsening renal function (WRF) is a common complication of the treatment of acute decompensated heart failure and can be precipitated by aggressive diuresis. The DOSE trial randomized patients to a high vs. low intensity loop diuretic strategy. Notably, the rate of WRF during the 72-hour intervention period was increased with the high dose strategy but post-discharge non-renal outcomes were similar. However, the long term renal outcomes in patients with WRF precipitated by aggressive diuresis have not been described.
Objective: To determine the long term renal outcomes of patients with WRF in the high and low dose arms of the DOSE trial.
Methods: Participants of the DOSE trial with data on renal function at baseline and 60 days were studied. To maximize the number of events, WRF was defined as any worsening in estimated glomerular filtration rate (eGFR) from randomization to 72 hours.
Results: In total, 224 patients (72.7%) in the DOSE trial population had data on renal function available at baseline and 60 days. Of this subset, 102 patients (45.5%) experienced WRF at 72 hours and these patients had an average 16.7 ± 12.0% worsening in eGFR. In patients with WRF that were randomized to the high dose strategy (n=58) eGFR improved from 44.9 ± 22.4 ml/min/1.73m2 at 72 hours to 53.1 ± 30.0 ml/min/1.73m2 (p<0.001) at 60 days. Notably, eGFR was not significantly different at 60 days compared to baseline in these patients (p=0.18). However, in patients with WRF randomized to the low dose strategy (n=44), eGFR did not significantly improve from 72 hours to 60 days (46.4 ± 18.1 ml/min/1.73m2 to 48.8 ± 22.4 ml/min/1.73m2, p=0.34) and eGFR at 60 days was significantly worse than baseline (p=0.02).
Conclusion: In the DOSE trial, WRF precipitated by an aggressive loop diuretic strategy was transient and not associated with worse eGFR at 60 days whereas WRF in the absence of aggressive diuresis was associated with long term decline in renal function. The mechanism underlying WRF may be important in driving long term renal outcomes.
Author Disclosures: J. Simon: None. I.E. Hall: None. C.O. Onyebeke: None. J. Schaub: None. M.A. Brisco: None. K. Modesto: None. M. Assefa: None. J.M. Testani: None.
- © 2015 by American Heart Association, Inc.