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

Publication ,  Journal Article
Gupta, A; Braunwald, E; McNulty, S; Felker, GM; Gilbert, EM; Alharethi, R; Lee, KL; Anstrom, KJ; Redfield, MM; Goldsmith, SR; O'Connor, CM ...
Published in: J Card Fail
November 2012

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.

Duke Scholars

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

November 2012

Volume

18

Issue

11

Start / End Page

837 / 844

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Obesity
  • Middle Aged
  • Male
  • Kidney Function Tests
  • Kidney
  • Humans
  • Heart Failure
  • Female
  • Diuretics
 

Citation

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Gupta, A., Braunwald, E., McNulty, S., Felker, G. M., Gilbert, E. M., Alharethi, R., … Litwin, S. E. (2012). Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy. J Card Fail, 18(11), 837–844. https://doi.org/10.1016/j.cardfail.2012.09.005
Gupta, Achal, Eugene Braunwald, Steven McNulty, G Michael Felker, E Michael Gilbert, Rami Alharethi, Kerry L. Lee, et al. “Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy.J Card Fail 18, no. 11 (November 2012): 837–44. https://doi.org/10.1016/j.cardfail.2012.09.005.
Gupta A, Braunwald E, McNulty S, Felker GM, Gilbert EM, Alharethi R, et al. Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy. J Card Fail. 2012 Nov;18(11):837–44.
Gupta, Achal, et al. “Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy.J Card Fail, vol. 18, no. 11, Nov. 2012, pp. 837–44. Pubmed, doi:10.1016/j.cardfail.2012.09.005.
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. Obesity and the response to intensified diuretic treatment in decompensated heart failure: a DOSE trial substudy. J Card Fail. 2012 Nov;18(11):837–844.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

November 2012

Volume

18

Issue

11

Start / End Page

837 / 844

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Obesity
  • Middle Aged
  • Male
  • Kidney Function Tests
  • Kidney
  • Humans
  • Heart Failure
  • Female
  • Diuretics