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Abstract: PO1804

Diuretic Resistance in Acute Decompensated Heart Failure with Preserved vs. Reduced Ejection Fraction

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Sharma, Akash, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Patel, Rahul, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Velagapudi, Chakradhar, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Bansal, Shweta, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Background

Loop diuretic resistance (DR) is one of the common causes of inadequate decongestion in patients hospitalized with acute decompensated heart failure (ADHF). However, DR has not been characterized in patients with HF with preserved ejection fraction (HFpEF).

Methods

In a post hoc analysis of a pilot study which evaluated the role of high-dose spironolactone in hospitalized ADHF patients with DR, we analyzed the prevalence and potential pathophysiologic factors of DR in HFpEF (n=20), and compared those with HF with reduced EF (HFrEF) (n=27). DR was defined as weight loss<1lb/day despite intravenous furosemide>160mg/day (at least one dose of 80mg/day) or no change in dyspnea 48H after admission with usual care.

Results

DR was observed in 10 (50%) of HFpEF subjects as compared to 10 (37%) of HFrEF subjects (p=ns). In general, patients with HFpEF were older, more female and obese, had more diabetes, higher systolic blood pressure and lower brain natriuretic peptide compared to HFrEF (Table 1). There was no difference in clinical presentation, eGFR and pulmonary arterial systolic pressure in DR-HFpEF vs. DR-HFrEF. However, urine sodium/potassium ratio, plasma renin activity and aldosterone were lower in DR-HFpEF as compared to DR-HFrEF, though still higher than diuretic responsive-HFpEF patients (Table 1). Weight loss in response to high-dose spironolactone was similar in DR-HFpEF and HFrEF (14±8.6 vs.14±13 lb).

Conclusion

Although the comparisons were not statistically significant due to small sample size; the results suggest that DR is more prevalent in HFpEF. Despite similar clinical features of congestion and response to high-dose spironolactone, a state of reduced neurohormonal activation points that additional factors might be contributing to DR in HFpEF compared to HFrEF patients.

Table 1: Baseline characteristics of HFrEF vs. HFpEF patients
 RS-HFrEF (n=17)DR-HFrEF (n=10)Total, HFrEF (n=27)RS-HFpEF (n=10)DR-HFpEF (n=10)Total, HFpEF (n=20)p-value
Age

Male (%)

Body Mass Index (kg/m2)
55 (11.1)

88

28.7 (4.2)
56 (14.8)

80

28.7 (8.3)
55 (12.3)

85

28.7 (6.0)
55 (11.6)

60

38 (9.3)
68 (15.7)

50

36.8 (7.6)
61 (15.0)

55

37.4 (8.4)
ns

<0.001

ns
Systolic blood pressure (mmHg)

Diastolic blood pressure (mmHg)

Peripheral Edema (%)

Pulmonary rales (%)
125
(20.7)


78 (15.5)


64.7

82.4
115
(18.5)


76 (14.8)


100

60
121
(20.2)


77 (15.0)


77.8

74
138.2
(14.9)


76.9 (17.2)


100

80
131.6
(21.8)


69 (10.6)


90

80
134.9
(18.5)


73 (14.5)


95

80
ns


ns


ns

<0.001
Diabetes

CKD (eGFR <60 ml/min)
29

59
30

60
30

59
60

50
70

70
65

60
<0.001

ns
eGFR (ml/min/1.73m2)

Urine Sodium/potassium ratio

Pulmonary congestion on X-ray
(%)

PASP on ECHO (mmHg)
61.6
(17.8)

7.59 (4.9)



88.2


43 (10.0)
60.2
(22.8)

4.25 (3.9)



80


45 (9.9)
61.0
(19.4)

6.26 (4.8)



85.2


44 (9.9)
68.4
(22.5)

5.30 (4.5)



80


40 (8.4)
54.3
(29.6)

2.48 (1.2)



80


50 (13.5)
61.4
(26.6)

3.89 (3.5)



80


45 (12.1)
ns

ns



ns


ns
Brain natriuretic peptide (pg/mL)


Renin activity (ng/mL/hour)


Aldosterone (ng/dL)


Antidiuretic hormone (pq/mL)


Epinephrine (pq/mL)



Norepinephrine (pq/mL)
1637
(2224)


2.50
(8.6)


5.20
(3.6)


4.00
(4.3)


35.50
(43.8)


730.5
(840.3)
1255
(783)


10.6
(37.1)


42.20
(32)


4.10
(4.1)


74
(116)


1557
(410)
1527
(1973.5)


6.90
(12.8)


7.90
(20.3)


4.00
(4.6)


42.00
(58)


849.50
(1005.3)
467
(604)


0.65
(3.9)


3.95
(3.6)


1.15
(1.7)


16.00
(19.8)


533.50
(295.3)
406
(310.8)


3.75
(9.3)


14.30
(17.6)


1.35
(1.5)


31.00
(22)


864.50
(322.8)
449
(330.5)


1.15
(9.6)


7.55
(12.3)


1.35
(1.9)


18.00
(26)


734.50
(443.3)
ns



ns



ns



ns




ns



ns

RS=Responsive, DR=Diuretic Resistant

Funding

  • Commercial Support