The impact of the first 24 h of loop diuretic on kidney function in acute decompensated heart failure
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ORIGINAL ARTICLE
The impact of the first 24 h of loop diuretic on kidney function in acute decompensated heart failure Mohannad Alshibani 1,2 & Samah Alshehri 1,2 & Ahmad Bakhaider 3 & Abdulelah Atbani 3 & Mahamad Ismail 3 & Basel Jazzar 3 & Khalid Eljaaly 1,2 & Abdulhamid Althagafi 1 & Ahmed Aljabri 1,4 Received: 19 September 2020 / Accepted: 29 October 2020 # Royal Academy of Medicine in Ireland 2020
Abstract 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 allcause 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. Keywords Acute kidney injury . ADHF . Hospital stay . Loop diuretics . Readmission
Introduction Heart failure (HF) is a chronic, progressive disorder characterized by structural and functional myocardial impairment causing a decline in ejection of blood, ventricular filling, and failure to sufficiently maintain enough blood supply to meet needs of the human body [1]. Common causes are coronary
* Mohannad Alshibani [email protected] 1
Faculty of Pharmacy, Department of Pharmacy Practice, King Abdulaziz University, PO Box 22252, Jeddah, Saudi Arabia
2
College of Pharmacy, University of Arizona, Tucson, USA
3
Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
4
Faculty of Pharmacy, Department of Pharmacy Practice, University of Tabuk, Tabuk, Saudi Arabia
artery disorders, hypertension, and atrial fibrillation [2, 3]. The most frequent pathogenesis of heart failure is attributed to reduced left ventricular function; however, other means of pathogenesis include ischemia-associated dysfunction, ventricular remodeling, and increased hemodynamic overload [4]. HF is believed to be associated with significant morbidity, and mortality. With more than 23 million people affected
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