Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy.

Journal Article (Journal Article)

BACKGROUND: Obesity could attenuate diuretic effectiveness in treatment of acute decompensated heart failure (HF). METHODS AND RESULTS: The DOSE trial randomized 308 subjects with acute HF to low- versus high-intensification intravenous diuretic therapy. We tested for statistical interactions between obesity and dosing strategy across clinical end points. After 72 hours of treatment, obese subjects (body mass index >30 kg/m(2); n = 173) had greater volume loss than nonobese subjects (n = 119) but similar improvements in dyspnea and freedom from congestion. Both groups had greater fluid loss with high-intensification treatment. Obese subjects had a higher incidence of worsening renal function (WRF) at 72 hours with low-intensification treatment, compared with nonobese subjects. In contrast, nonobese and obese subjects had similar incidence of WRF with high-intensification treatment. There were no differences between obese and nonobese subjects in time to discharge and 60-day freedom from death, emergency department visit, or rehospitalization. CONCLUSIONS: The incidence of WRF was greater in obese than in nonobese subjects with low-intensification treatment. However, the frequency of WRF was equivalent in obese and nonobese subjects with high-intensification treatment. Additional studies are needed to assess whether obese patients with acute HF benefit from an initial high-intensification treatment strategy.

Full Text

Duke Authors

Cited Authors

  • Gupta, A; Braunwald, E; McNulty, S; Felker, GM; Gilbert, EM; Alharethi, R; Lee, KL; Anstrom, KJ; Redfield, MM; Goldsmith, SR; O'Connor, CM; Bull, DA; Stehlik, J; Litwin, SE

Published Date

  • November 2012

Published In

Volume / Issue

  • 18 / 11

Start / End Page

  • 837 - 844

PubMed ID

  • 23141856

Pubmed Central ID

  • PMC3498464

Electronic International Standard Serial Number (EISSN)

  • 1532-8414

Digital Object Identifier (DOI)

  • 10.1016/j.cardfail.2012.09.005


  • eng

Conference Location

  • United States