Abstract
Background
Worsening renal function (WRF) and hypokalemia related to diuretic use for acute decompensated
heart failure (ADHF) are common and associated with poor prognosis. Low-dose dopamine
infusion improves renal perfusion; its effect on diuresis or renal function specifically
in ADHF is not known.
Methods and Results
Sixty consecutive ADHF patients (age 75.7 ± 11.2 years; 51.7% female; left ventricular
ejection fraction 35.3 ± 12.1%) were randomized, after receiving a 40 mg intravenous
furosemide bolus, to either high-dose furosemide (HDF, 20 mg/h continuous infusion
for 8 hours) or low-dose furosemide combined with low-dose dopamine (LDFD, furosemide
5 mg/h plus dopamine 5 μg kg−1 min−1 continuous infusion for 8 hours). Both strategies were compared for total diuresis,
WRF (defined as a rise in serum creatinine of >0.3 mg/dL from baseline to 24 hours),
electrolyte balance, and 60-day postdischarge outcomes. Mean hourly excreted urine
volume (272 ± 149 mL in HDF vs 278 ± 186 mL in LDFD group; P = .965) and changes in dyspnea score (Borg index: −4.4 ± 2.1 in HDF group vs −4.7
± 2.0 in LDFD group; P = .575) during the 8 hours of protocol treatment were similar in the two groups.
WRF was more frequent in the HDF (n = 9; 30%) than in the LDFD group (n = 2; 6.7%;
P = .042). Serum potassium changed from 4.3 ± 0.5 to 3.9 ± 0.4 mEq/L at 24 hours (P = .003) in the HDF group and from 4.4 ± 0.5 to 4.2 ± 0.5 mEq/L at 24 hours (P = .07) in the LDFD group. Length of stay and 60-day mortality or rehospitalization
rates (all-cause, cardiovascular, and worsening HF) were similar in the two groups.
Conclusions
In ADHF patients, the combination of low-dose furosemide and low-dose dopamine is
equally effective as high-dose furosemide but associated with improved renal function
profile and potassium homeostasis.
Clinical Trial Registration Information
ClinicalTrials.gov Identifier: NCT00937092 (http://clinicaltrials.gov/ct2/show/NCT00937092)
Key Words
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Article info
Publication history
Published online: September 06, 2010
Accepted:
July 7,
2010
Received in revised form:
May 29,
2010
Received:
March 22,
2010
Footnotes
All decisions regarding this manuscript were made by a guest editor.
See page 929 for disclosure information.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
