Palazzuoli Alberto, Testani Jeffrey M, Ruocco Gaetano, Pellegrini Marco, Ronco Claudio, Nuti Ranuccio
Department of Internal Medicine, Cardiovascular Diseases Unit, S Maria alle Scotte Hospital, University of Siena, Italy.
Department of Internal Medicine, Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, United States.
Int J Cardiol. 2016 Dec 1;224:213-219. doi: 10.1016/j.ijcard.2016.09.005. Epub 2016 Sep 10.
The question regarding the correct balance between optimal loop diuretic dose administration and best modality is under debate as well as the exact relation existing between congestion and renal dysfunction. We sought to evaluate the effects of different diuretic modalities (low [LD] versus high dose [HD]) and dose administration on decongestion, Worsening renal function (WRF) and outcome.
We retrospectively analyzed data of DIUR-HF study matching for LD vs HD (cut off 125mg/day), and diuretic efficiency (DE) (weight loss/40mg daily of furosemide). We also evaluated WRF rate (creatinine increase during hospitalization ≥0.3mg/dl or estimated glomerular filtration rate (eGFR) reduction ≥25%) together with decongestion.
HD patients (n.55) were older, more frequently affected by diabetes and chronic kidney disease (CKD) and demonstrated higher rate of inhospital WRF (65% vs 29% p=0.001) and 180-days adverse events (70% vs 23% p<0.001) respect to LD patients (n.41). Patients with low DE showed a higher 180days adverse events rate than higher DE patients (p=0.02). Univariate and multivariable analysis suggests a significant relationship between adverse events and low DE (patients with DE under median value) (U-HR=2.59 [1.44-4.64]; p=0.001. M-HR=3.16 [1.55-6.46]; p=0.002); continuous administration (HR=3.12 [1.65-5.91]; p<0.001) and WRF (HR=5.30 [2.79-10.09]; p<0.001) were also related with adverse events.
HD and poor DE are two conditions associated with adverse outcome. Both situations are the consequence of previous detrimental clinical status and they appear strictly related to WRF occurrence.
关于最佳襻利尿剂剂量给药与最佳方式之间的正确平衡问题以及充血与肾功能不全之间的确切关系仍存在争议。我们试图评估不同利尿剂方式（低剂量[LD]与高剂量[HD]）和剂量给药对充血、肾功能恶化（WRF）和预后的影响。
我们回顾性分析了DIUR-HF研究中匹配LD与HD（分界值为125mg/天）以及利尿剂效率（DE）（体重减轻/每日40mg呋塞米）的数据。我们还评估了WRF发生率（住院期间肌酐增加≥0.3mg/dl或估计肾小球滤过率[eGFR]降低≥25%）以及充血情况。
与LD组患者（n = 41）相比，HD组患者（n = 55）年龄更大，更常患有糖尿病和慢性肾脏病（CKD），且住院期间WRF发生率更高（65%对29%，p = 0.001）以及180天不良事件发生率更高（70%对23%，p < 0.001）。DE低的患者180天不良事件发生率高于DE高的患者（p = 0.02）。单因素和多因素分析表明不良事件与低DE（DE低于中位数的患者）之间存在显著关系（U-HR = 2.59 [1.44 - 4.64]；p = 0.001。M-HR = 3.16 [1.55 - 6.46]；p = 0.002）；持续给药（HR = 3.12 [1.65 - 5.91]；p < 0.001）和WRF（HR = 5.30 [2.79 - 10.09]；p < 0.001）也与不良事件相关。
HD和低DE是与不良预后相关的两种情况。这两种情况都是先前有害临床状态的结果，并且它们似乎与WRF的发生密切相关。
