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Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction
Author(s) -
Damman Kevin,
Kjekshus John,
Wikstrand John,
Cleland John G.F.,
Komajda Michel,
Wedel Hans,
Waagstein Finn,
McMurray John J.V.
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.462
Subject(s) - medicine , loop diuretic , diuretic , heart failure , furosemide , hazard ratio , renal function , ejection fraction , confidence interval , cardiology , randomized controlled trial , propensity score matching
Aim We aimed to study the relationships of loop diuretic dose with renal function and clinical outcomes in patients with chronic heart failure ( HF ). Methods and results Loop diuretic dose at baseline was recorded in patients included in the Controlled Rosuvastatin Multinational Trial in Heart Failure ( CORONA ). The relationship to change in estimated glomerular filtration rate ( eGFR ) over time and to the first occurrence of the composite outcome of cardiovascular ( CV ) death or hospitalization owing to HF was examined in propensity score matched cohorts. Of the 5011 patients, 2550, 745, and 449 were receiving >80 mg (high), 41–80 mg (medium) and ≤40 mg (low) of loop diuretics in furosemide equivalent daily dosages, respectively, which were used to assemble 229, 385, and 1045 pairs of propensity‐matched high, medium, and low dose cohorts. Compared with matched no loop diuretic groups, eGFR declined 0.3 ± 0.2, 0.3 ± 0.3 and 1.2 ± 0.5 mL /min/1.73 m 2 /year in the low‐, medium‐, and high‐dose groups, respectively. Compared with matched no loop diuretic groups, hazard ratios ( HR ) (95% confidence intervals) for outcome associated with low‐, medium‐ and high‐dose groups were 1.71 (1.41–2.06), 1.99 (1.50–2.64), and 2.94 (1.95–4.41), respectively. Higher loop diuretic dose was particularly associated with increased risk for hospitalization owing to HF : HR 4.80 (2.75–8.37), P < 0.001. Conclusions The use of loop diuretics was associated with a slightly greater rate of decline in eGFR , which did not vary significantly by diuretic dose.Loop diuretic dose was associated with higher risks of ( CV ) mortality and predominantly hospitalization owing to HF , which appeared to be higher among those receiving higher daily doses.