Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JACC Heart Fail. 2018 Oct;6(10):859-870. doi: 10.1016/j.jchf.2018.04.008. Epub 2018 Aug 8.
This study sought to compare a continuous infusion diuretic strategy versus an intermittent bolus diuretic strategy, with the addition of low-dose dopamine (3 μg/kg/min) in the treatment of hospitalized patients with heart failure with preserved ejection fraction (HFpEF).
HFpEF patients are susceptible to development of worsening renal function (WRF) when hospitalized with acute heart failure; however, inpatient treatment strategies to achieve safe and effective diuresis in HFpEF patients have not been studied to date.
In a prospective, randomized, clinical trial, 90 HFpEF patients hospitalized with acute heart failure were randomized within 24 h of admission to 1 of 4 treatments: 1) intravenous bolus furosemide administered every 12 h; 2) continuous infusion furosemide; 3) intermittent bolus furosemide with low-dose dopamine; and 4) continuous infusion furosemide with low-dose dopamine. The primary endpoint was percent change in creatinine from baseline to 72 h. Linear and logistic regression analyses with tests for interactions between diuretic and dopamine strategies were performed.
Compared to intermittent bolus strategy, the continuous infusion strategy was associated with higher percent increase in creatinine (continuous infusion: 16.01%; 95% confidence interval [CI]: 8.58% to 23.45% vs. intermittent bolus: 4.62%; 95% CI: -1.15% to 10.39%; p = 0.02). Low-dose dopamine had no significant effect on percent change in creatinine (low-dose dopamine: 12.79%; 95% CI: 5.66% to 19.92%, vs. no-dopamine: 8.03%; 95% CI: 1.44% to 14.62%; p = 0.33). Continuous infusion was also associated with greater risk of WRF than intermittent bolus (odds ratio [OR]: 4.32; 95% CI: 1.26 to 14.74; p = 0.02); no differences in WRF risk were seen with low-dose dopamine. No significant interaction was seen between diuretic strategy and low-dose dopamine (p > 0.10).
In HFpEF patients hospitalized with acute heart failure, low-dose dopamine had no significant impact on renal function, and a continuous infusion diuretic strategy was associated with renal impairment. (Diuretics and Dopamine in Heart Failure With Preserved Ejection Fraction [ROPA-DOP]; NCT01901809).
本研究旨在比较持续输注利尿剂策略与间歇性推注利尿剂策略，以及在射血分数保留的心力衰竭（HFpEF）住院患者中加入小剂量多巴胺（3μg/kg/min）的治疗效果。
HFpEF 患者在因急性心力衰竭住院时容易发生肾功能恶化（WRF）；然而，迄今为止，尚未研究针对 HFpEF 患者实现安全有效的利尿治疗的住院治疗策略。
在一项前瞻性、随机临床试验中，90 名因急性心力衰竭住院的 HFpEF 患者在入院后 24 小时内随机分为 4 种治疗组之一：1）每 12 小时静脉推注呋塞米；2）持续输注呋塞米；3）间歇性推注呋塞米加小剂量多巴胺；4）持续输注呋塞米加小剂量多巴胺。主要终点是从基线到 72 小时肌酐的变化百分比。进行线性和逻辑回归分析，并对利尿剂和多巴胺策略之间的相互作用进行检验。
与间歇性推注策略相比，持续输注策略与肌酐升高的百分比更高相关（持续输注：16.01%；95%置信区间[CI]：8.58%至 23.45%比间歇性推注：4.62%；95%CI：-1.15%至 10.39%；p=0.02）。小剂量多巴胺对肌酐变化百分比没有显著影响（小剂量多巴胺：12.79%；95%CI：5.66%至 19.92%，无多巴胺：8.03%；95%CI：1.44%至 14.62%；p=0.33）。与间歇性推注相比，持续输注也与更高的 WRF 风险相关（比值比[OR]：4.32；95%CI：1.26 至 14.74；p=0.02）；小剂量多巴胺对 WRF 风险没有显著影响。利尿剂策略和小剂量多巴胺之间没有显著的相互作用（p>0.10）。
在因急性心力衰竭住院的 HFpEF 患者中，小剂量多巴胺对肾功能没有显著影响，而持续输注利尿剂策略与肾功能损害相关。（心力衰竭伴射血分数保留的利尿剂和多巴胺[ROPA-DOP]；NCT01901809）。
