Diuretic efficacy of high dose furosemide in severe heart failure: Bolus injection versus continuous infusion

Dormans, Tom; Meyel, J. J. M. Van; Gerlag, P. G. G.; Tan, Yongjun; Rüssel, Frans G. M.; Smits, Paul

doi:10.1016/0735-1097(96)00161-1

Cited by 261 publications

(141 citation statements)

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“…Our study revealed that total urine output and natriuresis with CRI (i.e., persistent diuresis) were significantly greater than those with IB (i.e., temporary diuresis). These results are consistent with previous studies [1,9,36]. Our results may provide basic information related to urine output and natriuresis as models of short-and longacting loop diuretics.…”

Section: Discussionsupporting

confidence: 82%

“…In addition, they found that although pharmacokinetic parameters such as terminal halflife and renal clearance of furosemide were not significantly different among the groups in the study, urine output and sodium excretion increased in relation to the furosemide infusion times [22]. In human subjects, continuous infusion of furosemide results in greater diuresis than bolus therapy, despite the maximal plasma furosemide concentrations and amount of drug excreted in the urine being lower for continuous infusion than for bolus therapy [9,36]. In the present study, an increase in urine output was evident at 1 hr after IB, but the response was transient.…”

Section: Discussionmentioning

confidence: 99%

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Differences in the Duration of Diuretic Effects and Impact on the Renin-Angiotensin-Aldosterone System of Furosemide in Healthy Dogs

Hori

Ohshima

Kanai

et al. 2010

The Journal of Veterinary Medical Science

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ABSTRACT. Our aim was to investigate the differences in the duration of diuretic effects and impact on the renin-angiotensin-aldosterone (RAA) system of furosemide as a model of short-and long-acting loop diuretics. Anesthetized dogs (n=6) were randomized into placebo, intravenous bolus administration (IB) and chronic rate infusion (CRI) groups. This study was conducted with a crossover study. Furosemide (4 mg/kg) was diluted to 18 mL in sterile saline. Furosemide was infused at 0.5 mg/kg/hr for 8 hr in the CRI group or was injected at 0 and 4 hr (both 2 mg/kg) in the IB group. Blood and urine samples were collected at baseline and at 1, 2, 4, 5, 6 and 8 hr. Compared with the baseline, the IB group had a significantly increased urine output at 1 and 5 hr. The CRI group had a significantly increased urine output persisting for 4 hr compared with the baseline. Compared with the placebo group, 8-hr urine output and 8-hr sodium excretion were significantly increased in the IB and CRI groups; the values in the CRI group were significantly higher than those in the IB group. Eight-hour potassium excretion was significantly increased in the IB and CRI groups. The plasma aldosterone concentration was significantly elevated in the IB group at 8 hr. Duration of action may be a predominant cause of loop diuretic-related differences. Persistent diuresis may cause greater diuretic effects than transient diuresis, with less elevation of the plasma aldosterone concentration.KEY WORDS: canine, diuretic resistance, loop diuretics, plasma aldosterone concentrations.J. Vet. Med. Sci. 72(1): 13-18, 2010 Loop diuretics are recommended as a first-line therapy in the management of congestive heart failure (CHF) and are important in the symptomatic treatment [19]. They can be divided into short-acting ones, such as furosemide, and long-acting ones, such as azosemide and torasemide. Although furosemide is commonly used in clinical settings, its main complication is that patients with CHF develop resistance to loop diuretics due to a reduction in the glomerular filtration rate and an increase in sodium reabsorption at diuretic-insensitive sites in the nephron [6,10,11,28]. Additionally, furosemide activates the renin-angiotensinaldosterone (RAA) system and the sympathetic nervous system [14,16,32].In contrast to furosemide, previous studies have revealed that long-acting loop diuretics have clinical efficacy; they cause less activation of the RAA system, reduce diuretic resistance, improve ventricular fibrosis and decrease the mortality rate in both humans and animal models [7,17,23,37]. Furosemide treatment for 14 days leads to diuretic resistance in dogs, but this does not occur with torasemide [17]. In human clinical study, the myocardial collagen volume decreases with torasemide, but remains unchanged with furosemide [23]. Additionally, a recent study showed that torasemide is associated with lower mortality compared with furosemide in patients with CHF [7]. Similarly, our previous data suggested that azosemide causes mild and long...

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Differences in the Duration of Diuretic Effects and Impact on the Renin-Angiotensin-Aldosterone System of Furosemide in Healthy Dogs

Hori

Ohshima

Kanai

et al. 2010

The Journal of Veterinary Medical Science

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show abstract

“…The risk of further increasing the infusion must be weighed against the other options such as hemofiltration or ultrafiltration procedures. In such cases, the continuous infusion, when compared with the intermittent bolus administration, has been shown to be as effective and potentially safer in terms of adverse effects 52 . For furosemide, the maximum effective intravenous daily dose is 80-120 mg.…”

Section: Diuretics (Table 12)mentioning

confidence: 99%

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Bocchi¹,

Vilas-Boas²,

Perrone³

et al. 2005

Arq. Bras. Cardiol.

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“…Although the risk of ototoxicity may be reduced by a continuous infusion rather than bolus therapy. 22,17 But continuous diuretic infusion can also cause ototoxicity especially with rates above 4mg/ min. 3,11 iii.…”

Section: Ototoxicitymentioning

confidence: 99%

Refractory Edema with Congestive Heart Failure Stepwise Approaches Nephrology Perspectives

Gawad¹

2014

UNOAJ

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Diuretic efficacy of high dose furosemide in severe heart failure: Bolus injection versus continuous infusion

Abstract: We conclude that in patients with severe heart failure, high dose furosemide administered as a continuous infusion is more efficacious than bolus injection and causes less ototoxic side effects.

Cited by 261 publications

References 19 publications

Differences in the Duration of Diuretic Effects and Impact on the Renin-Angiotensin-Aldosterone System of Furosemide in Healthy Dogs

Differences in the Duration of Diuretic Effects and Impact on the Renin-Angiotensin-Aldosterone System of Furosemide in Healthy Dogs

I Diretriz Latino-Americana para avaliação e conduta na insuficiência cardíaca descompensada

Refractory Edema with Congestive Heart Failure Stepwise Approaches Nephrology Perspectives

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