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Effect of High-Dose Furosemide in Refractory Congestive Heart Failure

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Alessandro Oddone

Renal Unit, Ospedale Maggiore, Lodi, Italy

Maurizio Surian

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Claudio Panciroli

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Gianfranca Galloni

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Antonella Masa

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Vincenzo Caizzi

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Sebastiano Belletti

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Walter Raimondi Cominesi

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

Mario Orlandi

Division of Cardiology, Ospedale Maggiore, Lodi, Italy

High-dose firosemide is considered effective in primary renal sodium re tention but is not generally recom mended in congestive heart failure. In order to evaluate efficacy and safety of high-dose furosemide (>500 mg/day), the authors studied 20 patients (pts) resistant to therapy (including furose mide <500 mg/day) selected from 161 pts admitted for chronic heart failure. All refractory pts (15 men and 5 women, mean age sixty ± 12 years) were in NYHA class IV and showed hyponatremia (130±5 mEq/L) and im paired renal function (BUN 31±14 mg/dL, serum creatinine 1.3±0.3 mg/dL and BUN/creatinine ratio 23±7). In addition to digitalis, dopa mine, angiotensin-converting enzyme inhibitors, or vasodilators, IV high- dose furosemide (775±419 mg/day, 500-2000) was given for ten±five days under daily clinical and laboratory monitoring.

Three pts died of low-output syn drome while 16 pts were upgraded to NYHA class III and 1 pt to class II; a mean weight reduction of 7.3±2.9 kg in ten+five days (0.80±0.4 kg/day) and a mean di uresis increase of 88±57% oc curred. The maximal dose of furosemide did not correlate with serum creatinine but did correlate with BUN/creatinine ratio (r = 0.78, p<.001). Pts were discharged on with chronic heart failure, and 43 % in the subgroup in NYHA class IV with hyponatremia. High dose furosemide was effective for rapid removal of ex cess water and salt in "furosemide-re sistant" congestive heart failure. The relationship between renal impair ment and maximal furosemide doses seems to confirm the role of renal pharmacokinetics in the appearance of furosemide resistance.

Angiology, Vol. 41, No. 10, 862-868 (1990)
DOI: 10.1177/000331979004101008


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