Safety and Efficacy of Very High Dose Furosemide Continuous Infusions

Jessica Wilczynski, PharmD1, Matthew Decaro, MD, FACC, FACP2, Gregary Marhefka, MD, FACC, FACP2,
Brandi Thoma, PharmD, BCPS, BCCP1, Susan Varghese, PharmD, BCPS1, Ryan Watson, MD2, Ilya Danelich, PharmD, BCPS, BCCP3
1Department of Pharmacy; 2Division of Cardiology; 3Department of Transplantation, Thomas Jefferson University Hospital, Philadelphia, PA, USA

BACKGROUND EFFICACY RESULTS SAFETY RESULTS

• Fluid overload is treated with loop diuretics in patients with heart failure Characteristic n = 22 24 Hours After 48 Hours After
Endpoint Baseline p value p value
and in patients with acute kidney injury1,2 Infusion Initiation Infusion Initiation
Age, yrs (mean ± SD) 62 ± 15
• There are sparse data regarding use of very high dose continuous loop Male n (%) 14 (64)
SCr (g/dL) 2.6 (±1.4) 2.8 (±1.3) 0.65 2.7 (±1.4) 0.367
diuretic infusions. In some studies, very high doses were only used in
Heart Failure n (%) 15 (68)
outlying patients (maximum 160 mg/hour)3, 4
AKI n (%) 7 (32) Electrolyte Incidence 48 Hours Prior Incidence 48 Hours After
p value
• The use of very high dose furosemide continuous infusions at Thomas EF (mean ± SD) 40 ± 21
Abnormalities to Infusion Initiation Infusion Initiation
Jefferson University Hospital is a rare practice. These infusions range in Home Diuretic Dose (mg)
dose from 40-240 mg/hour, with no limitation on the duration 45 ± 82 K <3.5 mmol/L 0.29 (±0.46) 0.33 (±0.48) 0.666
(mean ± SD)
Mg <1.5 mEq/L 0.05 (±0.22) 0.00 (±0.00) 0.329
• The purpose of this study is to examine the efficacy and safety of very
high dose furosemide continuous infusions Na <125 mmol/L 0.05 (±0.22) 0.00 (±0.00) 0.329

• Two patients had one incidence of hypotension

METHODS • No incidence of ototoxicity

• This hospital institutional review board approved retrospective cohort

DISCUSSION
study included adult patients ≥18 years old who were hospitalized at
Thomas Jefferson University Hospital between April 2017 and January 2019
• These data show that very high dose furosemide continuous infusions at
Administered a doses of 40-240 mg/hr for durations of up to 171 hours are both efficacious
continuous furosemide and safe
infusion at a dose of ≥40
• Prospective, multi-center randomized controlled trials should be done to
mg/hr
further confirm the findings in this study

• The range of infusion doses was 40 mg to 240 mg/hr, with a mean of

Included: evaluated at 24 98 (±41) mg/hr CONCLUSION
Excluded: expired or started
and 48 hours prior to and at
RRT* within the first 24 • Total furosemide doses were higher after infusion initiation (p < 0.001)
3, 6, 12, 24, and 48 hour Very high dose furosemide continuous infusions provide a significant increase in
hours of infusion initiation
intervals post-infusion
• The range of infusion duration was 5 hours to 161 hours, with a mean diuresis without worsening renal function, disturbing electrolytes, or increasing
*RRT = renal replacement therapy
of 43(±36) hours the risk of ototoxicity
• Body weight decreased from baseline to 24 hours (p = 0.023).
Primary Endpoint
There was no difference in thiazide diuretic administration (p = 0.419)
Change in 24-hour UOP REFERENCES
Secondary
Efficacy Endpoints 1) Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart
failure: a report of the American College of Cardiology Foundation/American Heart Association Task
Change in 48-hour UOP Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239.
Change in 24-hour body weight 2) Section 3: Prevention and Treatment of AKI. Kidney Int Suppl (2011). 2012;2(1):37-68.
Total furosemide doses 3) Dormans TP, Van meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P. Diuretic efficacy of high dose
Number of thiazide diuretics furosemide in severe heart failure: bolus injection versus continuous infusion. J Am Coll Cardiol.
Safety Endpoints: 1996;28(2):376-82.
Acute kidney injury 4) Howard PA, Dunn MI. Aggressive diuresis for severe heart failure in the elderly. Chest.
2001;119(3):807-10.
Hypotension
Electrolyte abnormalities
Ototoxicity DISCLOSURE PANEL
• Descriptive statistics were calculated as mean ± SD and were compared by
The authors have nothing to disclose concerning possible financial or personal relationships with
using paired sample t-tests commercial entities that may have a direct or indirect interest in the subject matter of this presentation