The development of chronic diuretic resistance can be predicted during a heart-failure hospitalization. Results from the REDIHF registry
Blázquez-Bermejo, Zorba (Hospital Universitario 12 de Octubre (Madrid))
Farré, Núria (Universitat Autònoma de Barcelona. Departament de Medicina)
Llagostera-Martín, Marc (Hospital del Mar (Barcelona, Catalunya))
Caravaca Perez, Pedro (Hospital Universitario 12 de Octubre (Madrid))
Morán-Fernández, Laura (Hospital Universitario 12 de Octubre (Madrid))
Fort, Aleix (Hospital del Mar (Barcelona, Catalunya))
De-Juan, Javier (Hospital Universitario 12 de Octubre (Madrid))
Ruiz, Sonia (Institut Hospital del Mar d'Investigacions Mèdiques)
Delgado-Jiménez, Juan Francisco (Universidad Complutense de Madrid. Facultad de Medicina)

Date:	2020
Abstract:	Diuretic resistance (DR) is a common condition during a heart failure (HF) hospitalization, and is related to worse prognosis. Although the risk factors for DR during a HF hospitalization are widely described, we do not know whether the risk of chronic DR could be predicted during admission. We conducted a multicenter, prospective observational study between July 2017 and July 2019. All patients admitted for acute HF with intravenous diuretic treatment and at least one criterion of congestion on admission were invited to participate. Patients on renal replacement therapy, under intravenous diuretic treatment for >72 hours before screening and those who were unable to sign the informed consent were excluded. We monitored decongestion (physical exam, hemoconcentration, NTproBNP change and lung ultrasound) and DR (diuresis and weight loss per unit of 40mg furosemide and fractional excretion of sodium) on the fifth day of admission. Chronic DR was evaluate two months after hospitalization and was defined as persistent signs of congestion despite ≥80 mg furosemide per day. We compared variables from the hospitalization between patients with and without chronic DR. A multivariate logistic regression analysis was conducted to find predictors of chronic DR. A total of 105 patients were included in the study. Mean age was 74. 5±12. 0 years, 64. 8% were male and mean LVEF was 46±17%. In the two months follow-up, five patients have died and one patient has had a heart transplant. Of the 99 remaining patients, 21 patients (21. 2%) had chronic DR. The dose of furosemide before admission and the decrease in NT-proBNP ≤30% during admission were predictors of chronic DR in the multivariate analysis. We can predict during a HF hospitalization which patients will develop chronic DR. The dose of furosemide before admission and the change in NT-proBNP are independent predictors of chronic DR.
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Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	PloS one, Vol. 15 (october 2020) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0240098
PMID: 33007024

8 p, 479.8 KB

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