Diuretic response in patients with acute decompensated heart failure: Characteristics and clinical outcome - An analysis from RELAX-AHF

Adriaan A. Voors, Beth A. Davison, John R. Teerlink, G. Michael Felker, Gad Cotter, Gerasimos Filippatos, Barry H. Greenberg, Peter S. Pang, Bruce Levin, Tsushung A. Hua, Thomas Severin, Piotr Ponikowski, Marco Metra

Research output: Contribution to journalArticle

71 Scopus citations

Abstract

Aims We studied the characteristics and clinical outcome related to diuretic response and the effects of serelaxin in patients hospitalized for acute heart failure (AHF).

Methods and results RELAX-AHF was a double-blind, placebo-controlled trial, enrolling 1161 patients admitted to hospital for AHF who were randomized to 48 h i.v infusions of placebo or serelaxin (30 μg/kg per day) within 16 h from presentation. Diuretic response was defined as Δ weight kg/[(total i.v. dose)/40 mg] + [(total oral dose)/80 mg)] furosemide (or equivalent loop diuretic dose) up to day 5. Median diuretic response was -0.42 (-1.00, -0.14) kg/40 mg. A poor diuretic response was independently associated with Western-like region (Western Europe, North America, Israel, and Poland), lower diastolic blood pressure, the absence of oedema, higher blood urea nitrogen, and lower levels of aspartate aminotransferase and potassium (all P < 0.01). Randomization to serelaxin was associated with lower doses of i.v. loop diuretics and slightly less weight loss, resulting in a neutral effect on diuretic response. Worse diuretic response was independently associated both with less relief of dyspnoea, measured with a visual analogue scale (VAS) at day 5 (primary endpoint; P = 0.0002), and with a higher risk of cardiovascular death or rehospitalization for heart failure or renal failure through day 60 (secondary endpoint, P < 0.0001), but not with increased 180-day cardiovascular mortality (P = 0.507).

Conclusions In patients hospitalized for AHF, a poor diuretic response was associated with a poor in-hospital and early post-discharge clinical outcome. Serelaxin had a neutral effect on diuretic response. Trial registration: NCT00520806.

Original languageEnglish (US)
Pages (from-to)1230-1240
Number of pages11
JournalEuropean Journal of Heart Failure
Volume16
Issue number11
DOIs
StatePublished - Nov 1 2014

Keywords

  • Diuretic response
  • Heart failure
  • Renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Voors, A. A., Davison, B. A., Teerlink, J. R., Felker, G. M., Cotter, G., Filippatos, G., Greenberg, B. H., Pang, P. S., Levin, B., Hua, T. A., Severin, T., Ponikowski, P., & Metra, M. (2014). Diuretic response in patients with acute decompensated heart failure: Characteristics and clinical outcome - An analysis from RELAX-AHF. European Journal of Heart Failure, 16(11), 1230-1240. https://doi.org/10.1002/ejhf.170