Associations of worsening renal function with loop diuretics in patients with heart failure with different ejection fraction categories

Abstract

Background Heart failure patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) have different sensitivity to plasma volume change after decongestion, but the possible differential effects of loop diuretics dosage on worsening renal function (WRF) in heart failure (HF) categories remain unclear. Methods In 972 patients with HFpEF and 427 patients with HFrEF, we assessed the risk of WRF with the average daily furosemide equivalent dose, using multivariable logistic regression. WRF was defined as an increase in serum creatinine levels of more than 26.5 mmol/L during hospitalization. Results In patients with HFpEF and HFrEF, between-group differences in average daily furosemide equivalent dose (18.9 mg/d vs. 26.8 mg/d) and the prevalence of WRF (25.3% vs. 14.3%) were significant (p < 0.001). In multivariable-adjusted analyses, a doubling of the average furosemide equivalent dose was associated with higher risk of WRF in all patients, patients with HFpEF and HFrEF, with odds ratios amounting to 1.42, 1.41 and 1.60 (p ≤ 0.022), respectively. There was no interaction between heart failure categories and average furosemide equivalent dose (p = 0.37). The adjusted odds ratios of risk of WRF associated with intravenous furosemide were 1.26 (95% confidence interval [CI], 1.08–1.46; p = 0.002) in HFpEF but not significant in HFrEF(p = 0.099). Conclusions The risk of WRF was associated with higher furosemide dosage in both HF subtypes. Our observations highlight that close monitoring is required to prevent further renal impairment in all HF patients while using loop diuretics.