Randomized trial of high dose furosemide-hypertonic saline in acute decompensated heart failure with advanced renal disease

Background: Randomized trials have suggested a benefit of high dose furosemide-hypertonic saline infusion (F-HSS) compared to furosemide IV bolus infusion (F-IVB) in acute decompensated heart failure (ADHF) with preserved renal function. Creatinine (CR) >2mg/dL or BUN >60mg/dL led to exclusion from published trials. Our experience of 72 ADHF patients (pts) treated with F-HSS identified 15 with advanced renal disease, who diuresed with renal improvement. Methods: A double-blind, double-dummy randomized trial was designed testing F-HSS vs F-IVB in ADHF pts with advanced renal disease, for diuretic effect and renal response. From November 2009 to April 2011 after informed consent, 50 ADHF pts, with estimated glomerular filtration rates (eGFR) of <60mL/min were randomly assigned to a 30 minute infusion of 150mL 0.9% saline with 80mg furosemide IV bolus (control) or 150mL 2.4% saline with 250mg furosemide (treatment) and 0.9% saline IV bolus. Sixteen (64%) pts in the control group had the second or subsequent doses doubled versus 6 (24%) pts in the treatment group. The average doses administered was 5 in the control and 4 in the treatment groups. Baseline characteristics between control and treatment groups were similar, with the average age 79.6 ± 6.9 years and left ventricular ejection fraction <45% in 50% of pts. Results: (Table presented) Conclusion: F-HSS led to a non-significant, better diuresis but also BUN elevation from baseline when compared to F-IVB in pts with ADHF with advanced renal disease.