Does Long-Term Furosemide Therapy Cause Thiamine Deficiency in Patients with Heart Failure? A Focused Review

Abstract

Diuretic therapy is a cornerstone in the management of heart failure. Most studies assessing body thiamine status have reported variable degrees of thiamine deficiency in patients with heart failure, particularly those treated chronically with high doses of furosemide. Thiamine deficiency in patients with heart failure seems predominantly to be due to increased urine volume and urinary flow rate. There is also evidence that furosemide may directly inhibit thiamine uptake at the cellular level. Limited data suggest that thiamine supplementation is capable of increasing left ventricular ejection fraction and improving functional capacity in patients with heart failure and a reduced left ventricular ejection fraction who were treated with diuretics (predominantly furosemide). Therefore, it may be reasonable to provide such patients with thiamine supplementation during heart failure exacerbations.

Thiamine Therapy for Heart Failure: a Promise or Fiction?

“…It may be postulated that thiamine deficiency may worsen heart failure state in these patients [11,14]. However, the evidence for loop diuretics causing thiamine deficiency is limited due to the small sample size studies.…”

“…The increased urinary excretion of thiamine in patients with heart failure who are on high-dose loop diuretics, such as furosemide, is thought to be the most important factor contributing to thiamine deficiency in these patients ( Fig. 1) [11].…”

Thiamine deficiency in a patient with recurrent renal cell carcinoma who developed weight loss with normal appetite and loss of energy soon after nivolumab treatment

“…In the current case, the administration of furosemide was also begun after the start of nivolumab administration. Furosemide administration increases urinary vitamin B1 excretion (Rieck et al, 1999), and long-term, high-dose (80–240 mg) administration of diuretics in patients with heart failure, etc., may lead to a deficiency in water-soluble vitamins including vitamin B1 (Seligmann et al, 1991; Katta et al, 2016). The administration of furosemide in this case was low at 10 mg; nevertheless, it may have contributed to the TD.…”

Nutritional neuropathies

“…Acute thiamine deficiencies due to increased loss of thiamine have been reported secondary to hyperemesis gravidarum and chronic diarrhea . Patients with heart failure may have thiamine deficiency due to increased urine volume and flow rate with diuretics such as furosemide . Other causes of thiamine deficiency in heart failure include early satiety (poor intake), avoidance of sodium‐rich foods which contain thiamine, and increased lymphatic production due to increased venous pressure resulting in lymphatic obstruction and impaired intestinal absorption of thiamine .…”