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



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.


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


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.


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.


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

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Author information




MA, SA, and Aljabri designed the study. AB, BJ, MI, and Atbani collected the data. Althagafi, KE, Aljabri, SA, and MA double-checked the data collection. MA and SA managed and analyzed the data, and all authors helped interpret it. MA drafted the manuscript and all coauthors contributed to its revision and final approval.

Corresponding author

Correspondence to Mohannad Alshibani.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Unit of Biomedical Ethics Research Committee at King Abdulaziz University. All procedures performed in the current study were in accordance with the ethical standards of the institutional and national research committee.


All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Alshibani, M., Alshehri, S., Bakhaider, A. et al. The impact of the first 24 h of loop diuretic on kidney function in acute decompensated heart failure. Ir J Med Sci (2020).

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  • Acute kidney injury
  • ADHF
  • Hospital stay
  • Loop diuretics
  • Readmission