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- Title
Comparison of Bumetanide- and Metolazone-Based Diuretic Regimens to Furosemide in Acute Heart Failure.
- Authors
Ng, Tien M. H.; Konopka, Erica; Hyderi, Alifiya F.; Hshieh, Shenche; Tsuji, Yuki; Kim, Brian J.; Han, Song Y.; Phan, Duc H.; Jeng, Aaron I.; Lou, Mimi; Elkayam, Uri
- Abstract
Introduction: Limited data exist comparing the efficacy and safety of bumetanide- or metolazone-based diuretic regimens tofurosemide in acute heart failure (HF). Our purpose was to evaluate the comparative effect on urine output (UO) and renal functionbetween these regimens. Methods: A retrospective study of hospitalized HF patients treated with continuous infusionfurosemide (CIF), combination furosemide plus metolazone (F + M), or continuous infusion bumetanide (CIB). Primary end pointswere between regimen comparisons for change in mean hourly UO versus baseline and incidence of worsening renal function.Results: Data on 242 patients with acute HF (age 58 ± 12 years, 63% male, left ventricular ejection fraction 38% ± 17%) wereanalyzed (160 CIF, 42 F + M, 40 CIB). The mean duration of diuretic regimens was 41 ± 32 hours. Compared to baseline, allregimens increased mean hourly UO (P < .0001 for all), with greater increases with F + M (109±171 mL) and CIB (90±90 mL)compared to CIF (48±103 mL; P = .009). Incidence of worsening renal function was not different between regimens; however,blood urea nitrogen (BUN) tended to increase more with F + M (4.4 ± 9.8 mg/dL) and CIB (4.3 ± 9.7 mg/dL) than CIF(1.8 ± 10.8 mg/dL), P = .09. The incidence of hyponatremia was higher with F + M and CIB. Differences in UO, BUN, andhyponatremia were retained in the subgroup analysis limited to patients with baseline serum creatinine <1.5 mg/dL, where renalfunction between the groups was not different. Conclusion: Compared to CIF, F + M or CIB was associated with greaterincreases in UO. No difference in the incidence of worsening renal function was found; however, electrolyte abnormalities may bemore prevalent when furosemide is combined with metolazone or when bumetanide is used. These therapeutic differenceswarrant prospective study.
- Subjects
BUMETANIDE; DIURETICS; METOLAZONE; HEART failure treatment; FUROSEMIDE; THERAPEUTICS
- Publication
Journal of Cardiovascular Pharmacology & Therapeutics, 2013, Vol 18, Issue 4, p345
- ISSN
1074-2484
- Publication type
Article
- DOI
10.1177/1074248413482755