In HFpEF, continuous diuresis bumps creatinine: ROPA-DOP

  • Sharma K & al.
  • JACC Heart Fail
  • 7 Aug 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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.

Limitations

  • Single-center trial not powered to detect clinical outcomes.

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