Endocrinology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel.
Internal Medicine Department, Centro Hospitalar de São João.
J Cardiovasc Med (Hagerstown). 2020 Jan;21(1):21-26. doi: 10.2459/JCM.0000000000000896.
Diuretics are first-line drugs in symptomatic heart failure treatment. Diabetes mellitus has been suggested as a determinant of diuretic resistance. Studies comparing the dose and efficacy of diuretics in patients with and without diabetes are lacking. We aimed to study if furosemide dose differed according to diabetes status.
We studied two cohorts of heart failure patients: a cohort of acute heart failure patients consecutively hospitalized with the primary diagnosis of heart failure and another of stable and optimized patients followed in a heart failure clinic. Data on comorbidities and medication were abstracted from patients' files. Use and doses of furosemide were compared between diabetic and nondiabetic patients. Regression analysis was used to determine the association of variables with diuretic dose. The independent association of diabetes with furosemide dose was assessed using multivariate models.
We studied 865 heart failure patients: 601 acute heart failure patients and 264 chronic stable heart failure patients. Acute heart failure patients with diabetes were more likely to need intravenous diuretic therapy and they were also more often discharged under higher doses of furosemide. They needed extra 6-mg furosemide at discharge in comparison with their nondiabetics counterparts and had an independent 26% higher odds of being discharged with at least 80-mg furosemide. Chronic patients were also more frequently prescribed with furosemide and on higher doses, although, diabetes was not independently associated with the use of higher furosemide doses.
Diabetic patients are more intensively treated with the loop diuretic furosemide. In acute heart failure, diabetes is an independent predictor of furosemide dose.
利尿剂是治疗有症状心力衰竭的一线药物。糖尿病已被认为是利尿剂抵抗的决定因素。缺乏比较有和无糖尿病患者利尿剂剂量和疗效的研究。我们旨在研究呋塞米剂量是否因糖尿病状态而异。
我们研究了两个心力衰竭患者队列：一个连续住院的急性心力衰竭患者队列，其主要诊断为心力衰竭，另一个是稳定和优化的心力衰竭患者队列，在心力衰竭诊所接受随访。从患者的病历中提取合并症和药物治疗的数据。比较糖尿病和非糖尿病患者的呋塞米使用和剂量。回归分析用于确定变量与利尿剂剂量的关系。使用多变量模型评估糖尿病与呋塞米剂量之间的独立相关性。
我们研究了 865 例心力衰竭患者：601 例急性心力衰竭患者和 264 例慢性稳定心力衰竭患者。患有糖尿病的急性心力衰竭患者更有可能需要静脉利尿剂治疗，并且出院时更常接受更高剂量的呋塞米治疗。与非糖尿病患者相比，他们在出院时需要额外的 6 毫克呋塞米，并且出院时至少接受 80 毫克呋塞米治疗的可能性高出 26%。慢性患者也更频繁地开呋塞米处方和更高剂量，但糖尿病与使用更高剂量呋塞米无关。
糖尿病患者接受环利尿剂呋塞米的强化治疗。在急性心力衰竭中，糖尿病是呋塞米剂量的独立预测因子。
