The impact of the first 24 h of loop diuretic on kidney function in acute decompensated heart failure.

BACKGROUND

Because of the uncertainty in the appropriate initial loop diuretic dose in acute decompensated heart failure (ADHF), the risk of acute kidney injury (AKI) is believed to be increased with the high dose of initial intravenous (IV) loop diuretic.

AIMS: The purpose of this study is to examine the impact of the first 24-h IV diuretic on kidney function in ADHF.

METHODS

A retrospective cohort study included patients with ADHF. These patients were divided into two groups: the first group received an initial total IV diuretic dose that was equal to or 2.5 times less than the home dose in the first 24 h (low dose), while the second group received 2.5 times more than the home dose in the first 24 h (high dose). The primary outcome was the incidence of developing AKI within 48 h of first IV diuretic. The secondary outcomes were total hospital length of stay and all-cause 30-day readmission rates.

RESULTS

A total of 252 patients were available for analysis; 172 patients received a low dose in the first 24 h, while 80 patients received a high dose. The incidence of AKI was higher in the high-dose group compared to that in the low-dose group (25% vs. 9.9%, P = 0.002). There was no significant difference between the two groups in terms of hospital stay and all-cause 30-day readmission.

CONCLUSION

In patients with ADHF, the initial high dose of IV loop diuretics is associated with an increased risk of developing AKI.