Loop Diuretics Administration and Acute Heart Failure
Condition: Acute Heart Failure
MeSH terms: Heart Failure
Study type: Interventional
Phase: Phase 4

Summary: 
      Intravenous loop diuretics is the therapy most commonly used to treat pulmonary congestion
      and systemic fluid overload. In theory, continuous infusion should allow for a more
      consistent diuresis, avoiding the sodium reabsorption in the distal tubule as well as the
      neurohormonal activation. This should lead to renal function improvement and BNP decrease.
    

Detailed description: 
      Patients were eligible if they were admitted with a primary diagnosis of ADHF, randomized
      within 12 h after hospital presentation, and with evidence of volume overload (pulmonary
      congestion) on a chest X-ray study and had BNP levels >100 pg/ml. Patients also displayed
      mild to moderate renal dysfunction with creatinine values up to 1.4 mg/dl. Some patients were
      supported with non invasive ventilation before randomization. Once the initial 12 h dose was
      determined, patients were randomized using a 1:1 ratio using a computer-generated scheme to
      receive the furosemide dose either divided into a twice-daily bolus injection or in a
      continuous infusion (mixed as a 1:1 ratio in 5 % dextrose in water) for a time period ranging
      from 72 to 120 h. The randomization was casual, and the physicians did not previously know
      the assigned arm. The dose escalation and subsequent titration of furosemide was guided by
      clinical response in terms of urine output volume and body weight reduction .Before
      randomization, renal function parameters and BNP levels were measured in all patients.
      Subsequent titration of the furosemide dosage was at the discretion of the attending
      physician, but was guided by a dose-escalation algorithm based on the treatment response
      (weight loss and urine output volume), symptom improvement, changes in renal function,
      electrolyte balance, and chest radiography. The specific doses of furosemide and the use of
      additional agents to manage ADHF (dopamine, IV vasodilators, hypertonic saline infusion) were
      decided based upon blood pressure measurements, renal function evaluation and diuresis
      response. Supplementary treatment was left to the discretion of the treating physician. The
      duration of infusion was continued for up to 72 h, at 48 h the physicians had the possibility
      to adjust diuretic dose administration on the basis of the clinical response. After 72 h the
      treatment could be stopped or continued for an additional 36-48 h depending on the patient's
      condition and diuresis response. Acute kidney injury (AKI) was defined following the RIFLE
      criteria.

      Abbreviations:

      (AKI) Acute kidney injury (ADHF) Acute decompensated heart failure (BNP) B-type natriuretic
      peptide (CHD) Coronary heart disease (cIV) Continuous infusion (iIV) Intermittent infusione
      (eGFR)Estimated glomerular filtration rate (Hb) Hemoglobin (HF) Heart failure (Hct)
      Hematocrit (LVEF) Left ventricular ejection fraction (RBC) Red blood cells
    

Intervention name(s): furosemide infusion
Intervention type(s): Drug
Intervention description(s): Patients were randomized in a 1:1 ratio to receive furosemide dose divided into twice-daily bolus injection (group 0) or continuous infusion (group 1)(mixed as a 1:1 ratio in 5% dextrose in water) for a time period ranging from 72 to 120 hours. The mean daily diuretic dosage was similar in the two groups. The median time from presentation to randomization was 16 hours, and the median duration of study-drug administration was 112± 24 hours
Other intervention name(s): Continuous vs intermittent intravenous furosemide infusion
Intervention MeSH terms: Furosemide
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: acute heart failure; diuretics; BNP; Renal function; acute decompensated Heart Failure,; volume overload