Kefer Emily, Gulbis Brian, Weeks Phillip
Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX; and.
Department of Pharmacy, University of Texas Medical Branch, Galveston, TX.
J Cardiovasc Pharmacol. 2025 Mar 1;85(3):233-237. doi: 10.1097/FJC.0000000000001658.
Loop diuretics are a fundamental cornerstone in management of hypervolemia encountered in acute decompensated heart failure. There is variation in the literature describing relative potency of loop diuretic agents, and there are very limited available data specific to the heart failure population. In this retrospective cohort study, we aimed to compare the urine output response between intravenous furosemide and bumetanide in patients with acute decompensated heart failure. Patients were eligible for inclusion if they were admitted between July 1, 2021, and June 30, 2022, with acute decompensated heart failure and received intravenous bumetanide or furosemide within 48 hours of admission. Propensity matching was used to determine comparison groups. The primary outcome was total urine output for 24 hours after initiation of the diuretic regimen. A total of 120 patients (60 in each group) were matched after exclusion criteria were applied. The total urine output was similar between groups. The bumetanide group did demonstrate a greater urine output: furosemide-equivalent response (52 ± 46 mL/mg vs. 33 ± 25 mL/mg; P = 0.007). Based on our analysis, similar urine output may be achieved with either intravenous bumetanide or furosemide in acute decompensated heart failure; however, a higher dose of furosemide may be required than what has been previously established as an equivalent dose to bumetanide to achieve a similar diuretic effect. These results should warrant further investigation to better establish dose-response relationships with loop diuretics in acute decompensated heart failure.
袢利尿剂是治疗急性失代偿性心力衰竭中高血容量的重要基石。文献中对袢利尿剂的相对效力描述存在差异，且针对心力衰竭人群的可用数据非常有限。在这项回顾性队列研究中，我们旨在比较急性失代偿性心力衰竭患者静脉注射呋塞米和布美他尼后的尿量反应。如果患者在2021年7月1日至2022年6月30日期间因急性失代偿性心力衰竭入院，并在入院后48小时内接受静脉注射布美他尼或呋塞米，则符合纳入条件。采用倾向匹配法确定比较组。主要结局是开始利尿治疗方案后24小时的总尿量。在应用排除标准后，共匹配了120例患者（每组60例）。两组间总尿量相似。布美他尼组确实显示出更大的尿量：呋塞米等效反应（52±46 mL/mg对33±25 mL/mg；P = 0.007）。根据我们的分析，在急性失代偿性心力衰竭中，静脉注射布美他尼或呋塞米可能会产生相似的尿量；然而，可能需要比先前确定的与布美他尼等效剂量更高的呋塞米剂量才能达到相似的利尿效果。这些结果值得进一步研究，以更好地确定急性失代偿性心力衰竭中袢利尿剂的剂量-反应关系。
