Author + information
- Received January 30, 2018
- Revision received April 12, 2018
- Accepted April 17, 2018
- Published online September 24, 2018.
- Kavita Sharma, MDa,∗ (, )
- Joban Vaishnav, MDa,
- Rohan Kalathiya, MDa,
- Jiun-Ruey Hu, MD, MPHa,
- John Miller, MDa,
- Nishant Shah, MDa,
- Terence Hill, MDa,
- Michelle Sharp, MDa,
- Allison Tsao, MDa,
- Kevin M. Alexander, MDa,
- Richa Gupta, MDa,
- Kristina Montemayor, MDa,
- Lara Kovell, MDa,
- Jessica E. Chasler, PharmDa,
- Yizhen J. Lee, MDa,
- Derek M. Fine, MDb,
- David A. Kass, MDa,
- Robert G. Weiss, MDa,
- David R. Thiemann, MDa,
- Chiadi E. Ndumele, MD, PhDa,
- Steven P. Schulman, MDa,
- Stuart D. Russell, MDa,
- on behalf of the Osler Medical Housestaff
- aDepartment of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- bDivision of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Kavita Sharma, Advanced Heart Failure/Transplant Cardiology, The Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 568C, Baltimore, Maryland 21287.
Objectives This study sought to compare a continuous infusion diuretic strategy versus an intermittent bolus diuretic strategy, with the addition of low-dose dopamine (3 μg/kg/min) in the treatment of hospitalized patients with heart failure with preserved ejection fraction (HFpEF).
Background HFpEF patients are susceptible to development of worsening renal function (WRF) when hospitalized with acute heart failure; however, inpatient treatment strategies to achieve safe and effective diuresis in HFpEF patients have not been studied to date.
Methods In a prospective, randomized, clinical trial, 90 HFpEF patients hospitalized with acute heart failure were randomized within 24 h of admission to 1 of 4 treatments: 1) intravenous bolus furosemide administered every 12 h; 2) continuous infusion furosemide; 3) intermittent bolus furosemide with low-dose dopamine; and 4) continuous infusion furosemide with low-dose dopamine. The primary endpoint was percent change in creatinine from baseline to 72 h. Linear and logistic regression analyses with tests for interactions between diuretic and dopamine strategies were performed.
Results Compared to intermittent bolus strategy, the continuous infusion strategy was associated with higher percent increase in creatinine (continuous infusion: 16.01%; 95% confidence interval [CI]: 8.58% to 23.45% vs. intermittent bolus: 4.62%; 95% CI: −1.15% to 10.39%; p = 0.02). Low-dose dopamine had no significant effect on percent change in creatinine (low-dose dopamine: 12.79%; 95% CI: 5.66% to 19.92%, vs. no-dopamine: 8.03%; 95% CI: 1.44% to 14.62%; p = 0.33). Continuous infusion was also associated with greater risk of WRF than intermittent bolus (odds ratio [OR]: 4.32; 95% CI: 1.26 to 14.74; p = 0.02); no differences in WRF risk were seen with low-dose dopamine. No significant interaction was seen between diuretic strategy and low-dose dopamine (p > 0.10).
Conclusions In HFpEF patients hospitalized with acute heart failure, low-dose dopamine had no significant impact on renal function, and a continuous infusion diuretic strategy was associated with renal impairment. (Diuretics and Dopamine in Heart Failure With Preserved Ejection Fraction [ROPA-DOP]; NCT01901809)
- acute decompensated heart failure
- heart failure with preserved ejection fraction
- worsening renal function
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 30, 2018.
- Revision received April 12, 2018.
- Accepted April 17, 2018.
- 2018 American College of Cardiology Foundation
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