- For patients hospitalized with exacerbation of heart failure with preserved ejection fraction (HFpEF), infusion of continuous furosemide (Lasix, Validus Pharmaceuticals, Parsippany, NJ, USA) caused creatinine rise.
- Addition of low-dose dopamine had no discernible effect.
Why this matters
- No therapy is known to be effective in HFpEF.
- Typically preload-dependent, these patients may experience worsening renal function during hospitalization, making diuresis difficult.
- Continuous vs intermittent furosemide groups:
- Creatinine increase: 16.01% (95% CI, 8.58%-23.45%) vs 4.62% (95% CI, −1.15% to 10.39%; P=.02);
- Percentage experiencing increase ≥0.3 mg/dL: 36.2% vs 11.6% (P=.01);
- Similar urine output, weight change, N-terminal pro b-type natriuretic peptide change, symptoms, dyspnea, exercise capacity; and
- Similar 30-day and 1-year outcomes.
- Dopamine did not affect creatinine increase.
- Women, black patients, and patients with chronic kidney disease had steeper creatinine increase with continuous furosemide.
- ROPA-DOP was prospective randomized controlled single-blind trial at Johns Hopkins Hospital.
- Participants hospitalized with acute exacerbation of HFpEF (n=90) were randomly assigned to 1 of 4 diuretic regimens:
- Intermittent bolus furosemide with vs without low-dose dopamine;
- Continuous furosemide with vs without low-dose dopamine.
- Outcome: percentage change in creatinine, baseline vs 72 hours.
- Funding: None disclosed.
- Single-center trial not powered to detect clinical outcomes.