Gruber Amit, Abbo Aharon Ronnie, Volis Ina, Aronson Doron, Girerd Nicolas, Kristensen Søren Lund, Zukermann Robert, Alberkant Natalia, Sitnitsky Elena, Kruger Anton, Khasis Polina, Bravo Evgeny, Elad Boaz, Levin Ludmila Helmer, Caspi Oren
From the Heart Failure Unit, Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
ESC Heart Fail. 2025 Oct;12(5):3285-3295. doi: 10.1002/ehf2.15358. Epub 2025 Jul 15.
Oral diuretic treatment has limited efficacy in managing chronic heart failure (HF) patients. Novel strategies are needed to manage patients with refractory congestion despite optimal HF therapy and high-dose oral diuretic treatment. In the present study, we prospectively quantified the efficacy and safety of an ambulatory, weekly, high-dose parenteral diuresis strategy.
Data from the prospective, randomized, cross-over controlled study for comparisons of diuresis efficacy in HF patients (DEA-HF) were analysed. Chronic HF patients with congestion despite guideline-directed medical therapy were enrolled to receive three high-intensity diuretic regimens, once a week, in a randomized order: intravenous (IV) furosemide 250 mg; IV furosemide 250 mg + oral metolazone 5 mg; and IV furosemide 250 mg + IV acetazolamide 500 mg. The primary outcome compared the total sodium excretion following each diuretic regimen. Here, all regimens were pooled to assess the effect of weekly intensive diuresis approach on congestion parameters. The study population included 42 patients, 40% females, with a mean age of 72 ± 9 years. Following three consecutive weekly treatments, the mean body weight was decreased from 85.5 kg [95% confidence interval (CI): 79.7-91.2] to 83.1 kg (95% CI: 77.4-88.9. P = 0.0005), accompanied by a significant decrease in congestion score, N-terminal-pro-brain natriuretic peptide levels and lung ultrasound B-line count. Serum creatinine mildly but significantly increased from 1.81 mg/dL (95% CI: 1.62-2.01) to 2.01 mg/dL (95% CI: 1.81-2.21. P < 0.001), and no hospitalizations due to acute kidney injury occurred.
In patients with congestion-refractory HF, an ambulatory strategy utilizing high-intensity weekly IV diuretic therapy achieved effective decongestion without major safety concerns. This escalated strategy may improve clinical outcomes and prevent hospitalizations of chronic HF patients who require diuresis intensification.
口服利尿剂治疗在慢性心力衰竭（HF）患者管理中的疗效有限。对于尽管接受了最佳HF治疗和高剂量口服利尿剂治疗仍存在难治性充血的患者，需要新的治疗策略。在本研究中，我们前瞻性地量化了一种门诊每周高剂量肠外利尿策略的疗效和安全性。
分析了用于比较HF患者利尿效果的前瞻性、随机、交叉对照研究（DEA-HF）的数据。纳入尽管接受了指南指导的药物治疗仍存在充血的慢性HF患者，以随机顺序每周接受三种高强度利尿方案：静脉注射（IV）呋塞米250mg；IV呋塞米250mg + 口服美托拉宗5mg；以及IV呋塞米250mg + IV乙酰唑胺500mg。主要结局比较了每种利尿方案后的总钠排泄量。在此，将所有方案汇总以评估每周强化利尿方法对充血参数的影响。研究人群包括42例患者，40%为女性，平均年龄72±9岁。连续三周治疗后，平均体重从85.5kg[95%置信区间（CI）：79.7 - 91.2]降至83.1kg（95%CI：77.4 - 88.9，P = 0.0005），同时充血评分、N末端脑钠肽前体水平和肺部超声B线计数显著降低。血清肌酐从1.81mg/dL（95%CI：1.62 - 2.01）轻度但显著升高至2.01mg/dL（95%CI：1.81 - 2.21，P < 0.001），且未发生因急性肾损伤导致的住院情况。
在难治性充血性HF患者中，采用每周高强度IV利尿治疗的门诊策略可有效减轻充血，且无重大安全问题。这种逐步升级的策略可能改善临床结局并预防需要强化利尿的慢性HF患者的住院情况。
