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Title: | Loop diuretic down-titration in stable chronic heart failure is often achievable, especially when urinary chloride concentration is low | Authors: | VERBRUGGE, Frederik MARTENS, Pieter Boonen, Levinia NIJST, Petra Verhaert, David NOYENS, Patrick DE VUSSER, Philip DUPONT, Matthias Tang, W. H. Wilson MULLENS, Wilfried |
Issue Date: | 2018 | Publisher: | TAYLOR & FRANCIS LTD | Source: | ACTA CARDIOLOGICA, 73(4), p. 335-341 | Abstract: | Background: This study investigates spot urinary chloride concentration in euvolemic chronic heart failure (CHF) patients. Methods: This prospective cohort study included 50 ambulatory CHF patients on maintenance loop diuretics without recent hospital admission, clinical signs of volume overload, or adjustment in neurohumoral blocker or diuretic therapy. Spot urinary samples were collected immediately after loop diuretic intake. Subsequently, loop diuretic dose was reduced with 50% or stopped if <= 40mg furosemide equivalents. Successful down-titration was defined as persistent dose reduction after 7d without body weight increase >1.5kg. Results: Urinary chloride concentration was 3045 +/- 1271mg/L overall. Patients with higher versus lower urinary chloride concentrations took the same dose of loop diuretics [40 mg (20-40mg) furosemide equivalents; p value =.509] and had similar plasma NT-proBNP levels [1179ng/L (311-2195ng/L) versus 900ng/L (255-1622ng/L), respectively; p value = .461]. Down-titration was successful in 72% versus 76%, respectively (p value = 1.000). At 30d, loop diuretic dose remained reduced in 59% versus 76% of patients, respectively (p value = .238). The proportion of patients free from diuretic therapy was 45% versus 62% in the high versus low chloride concentration group (p value = .265). Conclusions: Loop diuretic down-titration was successful in 3 out of 4 euvolemic CHF patients, irrespectively of urinary chloride concentration on spot samples collected after diuretic intake. | Notes: | [Verbrugge, Frederik H.; Martens, Pieter; Boonen, Levinia; Nijst, Petra; Verhaert, David; Noyens, Patrick; De Vusser, Philip; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. [Martens, Pieter; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Heart & Vasc Inst, Dept Cardiovasc Med, Cleveland, OH 44106 USA. [Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. | Keywords: | Heart failure; plasma volume; sodium chloride; sodium potassium chloride symporter inhibitors;Heart failure; plasma volume; sodium chloride; sodium potassium chloride symporter inhibitors | Document URI: | http://hdl.handle.net/1942/27740 | ISSN: | 0001-5385 | e-ISSN: | 1784-973X | DOI: | 10.1080/00015385.2017.1385152 | ISI #: | 000443837100004 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2019 |
Appears in Collections: | Research publications |
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verbrugge2017.pdf Restricted Access | Published version | 1.14 MB | Adobe PDF | View/Open Request a copy |
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