Zheng Zhigui, Jiang Xinxin, Chen Jianguo, He Dongyuan, Xie Xiaohui, Lu Yunan
Department of Nephrology, Zhejiang Hospital, Gudun Road 1229, Hangzhou, Zhejiang Province, China.
ESC Heart Fail. 2021 Jun;8(3):2070-2078. doi: 10.1002/ehf2.13286. Epub 2021 Mar 10.
There is paucity of clinical data comparing continuous infusion (CI) with bolus injection (BI) of intravenous loop diuretics in patients with acute decompensated heart failure (ADHF) and chronic renal dysfunction. This study aimed to compare the efficacy and safety of CI versus BI intravenous furosemide administration in patients with ADHF and moderate chronic renal insufficiency.
Acute decompensated heart failure and moderate chronic renal insufficiency [with estimated glomerular filtration rate (eGFR) 15.0-44.9 mL/min/1.73 m ] were randomized to start intravenous furosemide by BI or by a 6 h CI. End points included freedom from congestion at 72 h, the degree of dyspnoea assessed using the 0-10 Borg's category ratio scale, net daily urine output, weight loss during the study, length of hospital stay, total urinary sodium excretion, and development of acute kidney injury or electrolyte disturbance. After 72 h of treatment, the rate of the primary endpoint of freedom from congestion in the CI group was significantly higher than that in the BI group (69.05% vs. 43.59%, P = 0.02). The modified Borg scale indicated patients in the CI group had lower dyspnoea score than those in the BI group at 48 h (4.29 ± 1.23 vs. 5.97 ± 1.56; P = 0.02) and 72 h (1.15 ± 0.35 vs. 2.66 ± 0.83; P = 0.003). There were other significant differences favouring the CI group with regard to net urine output at 72 h (5145.98 ± 621.37 mL vs. 3755.95 ± 456.93 mL; P = 0.007), the mean body weight loss (4.72 ± 1.01 kg vs. 3.53 ± 0.73 kg; P = 0.02) and the total urinary sodium excretion (385.05 ± 38.15 vs. 320.33 ± 37.67; P = 0.02). The length of hospitalization in the CI group was significantly shorter than that in the BI group (10.36 ± 4.20 days vs. 15.68 ± 6.15 days; P = 0.02). No significant differences were observed between groups in the frequency of acute kidney injury, tinnitus, electrolyte disturbance or mortality.
Continuous intravenous infusion of furosemide resulted in significantly greater diuresis than bolus administration of an equal dose in patients with moderate chronic renal insufficiency and ADHF, while no differences emerged in terms of side effects or mortality.
在急性失代偿性心力衰竭（ADHF）和慢性肾功能不全患者中，比较静脉注射袢利尿剂持续输注（CI）与大剂量注射（BI）的临床数据较少。本研究旨在比较ADHF和中度慢性肾功能不全患者中CI与BI静脉注射呋塞米的疗效和安全性。
将急性失代偿性心力衰竭和中度慢性肾功能不全[估计肾小球滤过率（eGFR）为15.0 - 44.9 mL/min/1.73 m²]患者随机分为通过BI或6小时CI开始静脉注射呋塞米。终点包括72小时无充血、使用0 - 10 Borg类别比例量表评估的呼吸困难程度、每日净尿量、研究期间体重减轻、住院时间、总尿钠排泄以及急性肾损伤或电解质紊乱的发生情况。治疗72小时后，CI组无充血这一主要终点发生率显著高于BI组（69.05%对43.59%，P = 0.02）。改良Borg量表显示，CI组患者在48小时（4.29 ± 1.23对5.97 ± 1.56；P = 0.02）和72小时（1.15 ± 0.35对2.66 ± 0.83；P = 0.003）时的呼吸困难评分低于BI组。在72小时净尿量（5145.98 ± 621.37 mL对3755.95 ± 456.93 mL；P = 0.007）、平均体重减轻（4.72 ± 1.01 kg对3.53 ± 0.73 kg；P = 0.02）和总尿钠排泄（385.05 ± 38.15对320.33 ± 37.67；P = 0.02）方面，CI组也有其他显著优势。CI组的住院时间显著短于BI组（10.36 ± 4.20天对15.68 ± 6.15天；P = 0.02）。两组在急性肾损伤、耳鸣、电解质紊乱或死亡率方面未观察到显著差异。
对于中度慢性肾功能不全和ADHF患者，静脉持续输注呋塞米比等量推注导致的利尿作用显著更强，而在副作用或死亡率方面没有差异。
