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Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials

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Abstract

Diuretics have an essential role in the management of heart failure (HF). However, each drug has its own benefit and side effect. Side effects include fluid, electrolyte abnormalities, and acid-base disturbance. These adverse effects of diuretics predispose patients to serious cardiac arrhythmias and may increase the risk of arrhythmic mortality. Herein, we aim to summarize the relative efficacy and safety of all available diuretics used in the treatment of patients with HF. In June 2017, a systematic electronic database search was conducted in nine databases. All randomized controlled trials (RCTs) comparing the different diuretics used in HF were included for meta-analysis. The protocol was registered in Prospero with CRD42018084819. Among the included 54 studies (10,740 patients), 34 RCTs were eligible for quantitative network meta-analysis (NMA) and traditional meta-analysis while the other 20 studies were qualitatively analyzed. Our results showed that azosemide and torasemide caused a significant reduction in brain natriuretic peptide (BNP) level. Torasemide also caused a significant decrease in collagen volume fraction (CVF) and edema. No significant difference between the agents concerning glomerular filtration rate (GFR), water extraction, and sodium excretion was demonstrated. Regarding side effects, no significant difference among diuretics was observed in terms of hospital readmission and mortality rates. Diuretics are the main treatment of hypervolemia in HF patients. The choice of appropriate diuretic is essential for successful management and is mainly guided by patient clinical situations and the presence of other co-morbidities.

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Acknowledgments

Thanks to Tran Thai Huu Loc, Ahmed Bendary, and Thanh Nguyen for their help in the early stages of the study.

Code availability

All used software applications and codes are available.

Funding

This study was conducted (in part) at the Joint Usage/Research Center on Tropical Disease, Institute of Tropical Medicine, Nagasaki University, Japan.

Author information

Author notes

  1. Peter Samuel Eid, Doaa Alaa Ibrahim and Ahmad Helmy Zayan contributed equally to this work.

Authors and Affiliations

  1. Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Peter Samuel Eid, Doaa Alaa Ibrahim & Manal Mahmoud Abd Elrahman

  2. Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan

    Peter Samuel Eid, Doaa Alaa Ibrahim, Ahmad Helmy Zayan, Manal Mahmoud Abd Elrahman, Mostafa Ahmed Abdo Shehata, Hend Kandil, Mahmoud Ahmed Abouibrahim, Luc Minh Duy, Ashraf Shinkar, Muhammed Khaled Elfaituri, Le Huu Nhat Minh, Mostafa Mahmoud Fahmy, Dao Ngoc Hien Tam, Nguyen Lam Vuong & Jaffer Shah

  3. Menoufia University, Menoufia, Egypt

    Ahmad Helmy Zayan

  4. Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Mostafa Ahmed Abdo Shehata

  5. Faculty of Medicine, Menoufia University, Menoufia, Egypt

    Hend Kandil

  6. Faculty of Medicine, Cairo University, Cairo, Egypt

    Mahmoud Ahmed Abouibrahim

  7. Pham Ngoc Thach University of Medicine, Ho Chi Minh, 700000, Vietnam

    Luc Minh Duy

  8. Psychiatry Department, Ain Shams University, Cairo, Egypt

    Ashraf Shinkar

  9. Faculty of Medicine, University of Tripoli, Tripoli, Libya

    Muhammed Khaled Elfaituri

  10. University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Le Huu Nhat Minh & Nguyen Lam Vuong

  11. Faculty of Medicine, Tanta University, Tanta, Egypt

    Mostafa Mahmoud Fahmy

  12. Nanogen Pharmaceutical Biotechnology Joint Stock Company, Ho Chi Minh city, 700000, Vietnam

    Dao Ngoc Hien Tam

  13. Drexel University College of Medicine, Philadelphia, PA, USA

    Jaffer Shah

  14. Tam Duc Cardiology Hospital, Ho Chi Minh City, Vietnam

    Van Buu Dan Do

  15. Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan

    Kenji Hirayama

  16. Institute of Research and Development, Duy Tan University, Da Nang, 550000, Vietnam

    Nguyen Tien Huy

Authors
  1. Peter Samuel Eid
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  2. Doaa Alaa Ibrahim
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  3. Ahmad Helmy Zayan
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  4. Manal Mahmoud Abd Elrahman
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  14. Nguyen Lam Vuong
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  17. Kenji Hirayama
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  18. Nguyen Tien Huy
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Contributions

PSE and NTH proposed the idea and designed the study. All authors participate in searching data bases, screening, data extraction, manuscript revision, and approved the final version of manuscript. PSE, NLV, NTH, and AHZ performed the descriptive analysis and wrote the manuscript.

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Correspondence to Nguyen Tien Huy.

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Eid, P.S., Ibrahim, D.A., Zayan, A.H. et al. Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials. Heart Fail Rev 26, 127–136 (2021). https://doi.org/10.1007/s10741-020-10003-7

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