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Renal function on admission modifies prognostic impact of diuretics in acute heart failure: a propensity score matched and interaction analysis

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Abstract

Although intravenous diuretics have been mainstay drugs in patients with acute heart failure (AHF), they have been suggested to have some deleterious effects on prognosis. We postulated that renal function may modify their deleterious effects in AHF patients. The study population consisted of 1094 AHF patients from three hospitals. Renal dysfunction (RD) was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on admission, and the cohort was divided into a high-dose furosemide (≥100 mg/48 h) and low-dose furosemide group according to the amount of intravenous furosemide used within 48 h from admission. In the whole cohort, in-hospital mortality rate was higher in the high-dose furosemide group than the low-dose furosemide group (12.5 vs. 6.6 %, respectively, P = 0.001). However, this difference in the in-hospital mortality rates was significant only in the RD subgroup (15.6 vs. 7.0 %, respectively, P < 0.001), and not in the non-RD subgroup (2.5 vs. 5.9 %, respectively, P = 0.384). Propensity score-matched analysis was performed to evaluate the impact of high-dose furosemide on prognosis. After propensity score matching, high-dose furosemide was not associated with in-hospital mortality (OR 1.25, 95 % CI 0.73–2.16, P = 0.408). However, there was a qualitative difference in OR for in-hospital mortality between AHF with RD (OR 1.77, 95 % CI 0.96–3.28, P = 0.068) and without RD (OR 0.23, 95 % CI 0.05–1.10, P = 0.064), and there was a significant interaction between eGFR and prognostic impact of high-dose furosemide (P for OR interaction = 0.013). An inverse relationship was observed between eGFR and OR for in-hospital death in the group treated with high-dose furosemide (decreasing OR with better eGFR). The deleterious effect of diuretics was significantly modified with renal function in AHF. This association may be one reason for poorer prognosis of AHF patients complicated with renal impairment.

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References

  1. Felker GM, Leimberger JD, Califf RM, Cuffe MS, Massie BM, Adams KF Jr, Gheorghiade M, O’Connor CM (2004) Risk stratification after hospitalization for decompensated heart failure. J Card Fail 10:460–466

    Article  PubMed  Google Scholar 

  2. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV (2003) Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 290:2581–2587

    Article  CAS  PubMed  Google Scholar 

  3. Setoguchi M, Hashimoto Y, Sasaoka T, Ashikaga T, Isobe M (2015) Risk factors for rehospitalization in heart failure with preserved ejection fraction compared with reduced ejection fraction. Heart Vessels 30:595–603

    Article  PubMed  Google Scholar 

  4. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CS, Sato N, Shah AN, Gheorghiade M (2014) The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 63:1123–1133

    Article  PubMed  Google Scholar 

  5. Sakata Y, Shimokawa H (2013) Epidemiology of heart failure in Asia. Circ J 77:2209–2217

    Article  PubMed  Google Scholar 

  6. Sato N (2013) Critical issue in the cardiovascular field: hospitalization for heart failure. J Cardiol 62:140–141

    Article  PubMed  Google Scholar 

  7. Scott JE, Bosworth TR (1990) The comparative chemical morphology of the mammalian cornea. Basic Appl Histochem 34:35–42

    CAS  PubMed  Google Scholar 

  8. Francis GS, Siegel RM, Goldsmith SR, Olivari MT, Levine TB, Cohn JN (1985) Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. Ann Intern Med 103:1–6

    Article  CAS  PubMed  Google Scholar 

  9. Cooper HA, Dries DL, Davis CE, Shen YL, Domanski MJ (1999) Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction. Circulation 100:1311–1315

    Article  CAS  PubMed  Google Scholar 

  10. Ahmed A, Husain A, Love TE, Gambassi G, Dell’Italia LJ, Francis GS, Gheorghiade M, Allman RM, Meleth S, Bourge RC (2006) Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods. Eur Heart J 27:1431–1439

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nakada Y, Takahama H, Kanzaki H, Sugano Y, Hasegawa T, Ohara T, Amaki M, Funada A, Yoshida A, Yasuda S, Ogawa H, Anzai T (2015) The predictability of renin–angiotensin–aldosterone system factors for clinical outcome in patients with acute decompensated heart failure. Heart Vessels. doi:10.1007/s00380-015-0688-7

    PubMed  Google Scholar 

  12. Triposkiadis F, Karayannis G, Giamouzis G, Skoularigis J, Louridas G, Butler J (2009) The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications. J Am Coll Cardiol 54:1747–1762

    Article  CAS  PubMed  Google Scholar 

  13. Sarraf M, Masoumi A, Schrier RW (2009) Cardiorenal syndrome in acute decompensated heart failure. Clin J Am Soc Nephrol 4:2013–2026

    Article  CAS  PubMed  Google Scholar 

  14. Butler J, Chirovsky D, Phatak H, McNeill A, Cody R (2010) Renal function, health outcomes, and resource utilization in acute heart failure: a systematic review. Circ Heart Fail 3:726–745

    Article  PubMed  Google Scholar 

  15. Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, Redfield MM, Deswal A, Rouleau JL, LeWinter MM, Ofili EO, Stevenson LW, Semigran MJ, Felker GM, Chen HH, Hernandez AF, Anstrom KJ, McNulty SE, Velazquez EJ, Ibarra JC, Mascette AM, Braunwald E, Heart Failure Clinical Research Network (2012) Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 367:2296–2304

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chen HH, Anstrom KJ, Givertz MM, Stevenson LW, Semigran MJ, Goldsmith SR, Bart BA, Bull DA, Stehlik J, LeWinter MM, Konstam MA, Huggins GS, Rouleau JL, O’Meara E, Tang WH, Starling RC, Butler J, Deswal A, Felker GM, O’Connor CM, Bonita RE, Margulies KB, Cappola TP, Ofili EO, Mann DL, Davila-Roman VG, McNulty SE, Borlaug BA, Velazquez EJ, Lee KL, Shah MR, Hernandez AF, Braunwald E, Redfield MM, Network NHFCR (2013) Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA 310:2533–2543

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446

    Article  CAS  PubMed  Google Scholar 

  18. Maisel A (2002) B-type natriuretic peptide levels: diagnostic and prognostic in congestive heart failure: what’s next? Circulation 105:2328–2331

    Article  PubMed  Google Scholar 

  19. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, ESC Committee for Practice Guidelines (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847

    Article  PubMed  Google Scholar 

  20. Horio M, Imai E, Yasuda Y, Watanabe T, Matsuo S (2010) Modification of the CKD epidemiology collaboration (CKD-EPI) equation for Japanese: accuracy and use for population estimates. Am J Kidney Dis 56:32–38

    Article  PubMed  Google Scholar 

  21. Rubin DB (1987) Multiple imputation for nonresponse in surveys. Wiley, New York, pp 1–250

    Google Scholar 

  22. Testani JM, Cappola TP, Brensinger CM, Shannon RP, Kimmel SE (2011) Interaction between loop diuretic-associated mortality and blood urea nitrogen concentration in chronic heart failure. J Am Coll Cardiol 58:375–382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399–424

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  25. He XR, Greenberg SG, Briggs JP, Schnermann J (1995) Effects of furosemide and verapamil on the NaCl dependency of macula densa-mediated renin secretion. Hypertension 26:137–142

    Article  CAS  PubMed  Google Scholar 

  26. Peacock WF, Costanzo MR, De Marco T, Lopatin M, Wynne J, Mills RM, Emerman CL, ADHERE Scientific Advisory Committee and Investigators (2009) Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE registry. Cardiology 113:12–19

    Article  PubMed  Google Scholar 

  27. Yilmaz MB, Gayat E, Salem R, Lassus J, Nikolaou M, Laribi S, Parissis J, Follath F, Peacock WF, Mebazaa A (2011) Impact of diuretic dosing on mortality in acute heart failure using a propensity-matched analysis. Eur J Heart Fail 13:1244–1252

    Article  CAS  PubMed  Google Scholar 

  28. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O’Connor CM, Network NHFCR (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364:797–805

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Miura M, Shiba N, Nochioka K, Takada T, Takahashi J, Kohno H, Shimokawa H, Investigators C- (2012) Urinary albumin excretion in heart failure with preserved ejection fraction: an interim analysis of the CHART 2 study. Eur J Heart Fail 14:367–376

    Article  CAS  PubMed  Google Scholar 

  30. Vergaro G, Emdin M, Iervasi A, Zyw L, Gabutti A, Poletti R, Mammini C, Giannoni A, Fontana M, Passino C (2011) Prognostic value of plasma renin activity in heart failure. Am J Cardiol 108:246–251

    Article  CAS  PubMed  Google Scholar 

  31. Poletti R, Vergaro G, Zyw L, Prontera C, Passino C, Emdin M (2013) Prognostic value of plasma renin activity in heart failure patients with chronic kidney disease. Int J Cardiol 167:711–715

    Article  PubMed  Google Scholar 

  32. Testani JM, McCauley BD, Chen J, Coca SG, Cappola TP, Kimmel SE (2011) Clinical characteristics and outcomes of patients with improvement in renal function during the treatment of decompensated heart failure. J Card Fail 17:993–1000

    Article  PubMed  PubMed Central  Google Scholar 

  33. Brisco MA, Coca SG, Chen J, Owens AT, McCauley BD, Kimmel SE, Testani JM (2013) Blood urea nitrogen/creatinine ratio identifies a high-risk but potentially reversible form of renal dysfunction in patients with decompensated heart failure. Circ Heart Fail 6:233–239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Mentz RJ, Stevens SR, DeVore AD, Lala A, Vader JM, AbouEzzeddine OF, Khazanie P, Redfield MM, Stevenson LW, O’Connor CM, Goldsmith SR, Bart BA, Anstrom KJ, Hernandez AF, Braunwald E, Felker GM (2015) Decongestion strategies and renin–angiotensin–aldosterone system activation in acute heart failure. JACC Heart Fail 3:97–107

    Article  PubMed  Google Scholar 

  35. Vasko MR, Cartwright DB, Knochel JP, Nixon JV, Brater DC (1985) Furosemide absorption altered in decompensated congestive heart failure. Ann Intern Med 102:314–318

    Article  CAS  PubMed  Google Scholar 

  36. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013) 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128:1810–1852

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Kameda Medical Center, 929, Higashi-cho, Kamogawa, Chiba, Japan

    Yuya Matsue, Makoto Suzuki, Akihiko Matsumura & Yuji Hashimoto

  2. Trauma and Acute Critical Care Medical Center, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan

    Atsushi Shiraishi

  3. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan

    Nobuyuki Kagiyama & Kiyoshi Yoshida

  4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Kazuki Yoshida

  5. Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan

    Teruyoshi Kume

  6. First Department of Internal Medicine, Nara Medical University, Kashihara, Japan

    Hiroyuki Okura

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  1. Yuya Matsue
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Correspondence to Yuya Matsue.

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Conflict of interest

Y. M. received an honorarium from Otsuka Pharmaceuticals. K. Y. receives tuition support jointly from Japan Student Services Organization and Harvard T. H. Chan School of Public Health (partially supported by training grants from Pfizer, Takeda, Bayer, and PhRMA). M. S. has received honoraria from Otsuka Pharmaceutical Co., Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Medtronic, Boston Scientific, and Fukuda Denshi. Other authors have nothing to disclose.

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Matsue, Y., Shiraishi, A., Kagiyama, N. et al. Renal function on admission modifies prognostic impact of diuretics in acute heart failure: a propensity score matched and interaction analysis. Heart Vessels 31, 1980–1987 (2016). https://doi.org/10.1007/s00380-016-0817-y

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