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DAD-HF: Low-dose furosemide yielded similar efficacy to high-dose in acute decompensated HF
The effects on renal function were similar between treatment groups.
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Heart Failure Society of American 13th Annual Scientific Meeting
Low-dose furosemide combined with low-dose dopamine had similar effects to high-dose furosemide on the improvement of renal function, dyspnea and clinical outcomes in patients with acute decompensated HF.
Researchers for the DAD-HF pilot trial enrolled 50 consecutive patients with acute decompensated HF and randomly assigned them to either a high dose of furosemide (Lasix, Sanofi-Aventis; n=25) or a low dose of furosemide plus a low dose of dopamine (n=25). Efficacy endpoints included changes in urine volume at 24 hours, improvement of dyspnea at 24 hours, worsening renal function at 24 hours and 60-day mortality or rehospitalization from all-cause, CV causes and non-CV causes or worsening HF.
According to the study results, there were no changes in hourly urine volume between the study groups for the duration of the study. Dyspnea Borg index improved at 24 hours compared with baseline measurements in both the high-dose group (7.47 to 2.84; P< .01) and the low-dose group (7.17 to 2.50; P<.01), and there was an increase in blood urea nitrogen in the high-dose group (from 43.2 mg/dL to 51.2 mg/dL; P<.01). Increases in serum creatinine levels .0.3 mg/dL occurred in nine patients (36%) in the high-dose group vs. one patient (4%) in the low-dose group (P= .005 between-group comparison), and a 12.8% reduction in serum potassium levels in the high-dose group vs. a 5.6% reduction in the low-dose group (P= .015) was observed. No differences in 60-day clinical outcomes were reported.
“The combination of low-dose furosemide and dopamine is equally effective and safer than high-dose furosemide, as it reduces the risk for worsening renal function and hypokalemia among hospitalized patients with acute decompensated HF,” Filippos Triposkiadis, MD, a cardiologist at University Hospital of Larissa in Larissa, Greece, said in his presentation. “However, larger studies are required to replicate these results and to further elucidate the effect of dopamine on renal function in patients with acute decompensated HF.” – by Eric Raible
This is a very important pilot trial and a critical issue to study. For a small trial, the researchers obviously have limited ability to look at clinical endpoints. There was a very striking difference in worsening renal function, especially in light of the PROTECT trial, which was a 2,000-patient experience trying to demonstrate improvement or preservation of renal function, and here we have a very dramatic difference in a small study. It will be very interesting to see if this can be replicated moving on to larger studies. What is the mechanism of this operation? Is it related to the furosemide dosing? Is it related to the dopamine? It is difficult to tease out.
– G. Michael Felker, MD
Assistant Professor of Medicine, Duke University School of Medicine
For more information:
- Triposkiadis F. LBCT II. Presented at: Heart Failure Society of America 13th Annual Scientific Meeting; Sept. 13-16, 2009; Boston.