Evidence map›Paper›PMID 24379278›Full record

Trial reportCirculation. Heart failure2014

Loop diuretic efficiency: a metric of diuretic responsiveness with prognostic importance in acute decompensated heart failure.

Jeffrey M Testani, Meredith A Brisco, Jeffrey M Turner, Erica S Spatz, Lavanya Bellumkonda, Chirag R Parikh, W H Wilson Tang

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation. Heart failure, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04298229 (A Randomized, Open-label Study of Dapagliflozin in Patients With or Without Type 2 Diabetes Admitted With Acute Heart Failure), which is not on this map. Cited by 142 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
142citing papers in PubMed, 3 pooled it
23.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04298229 phase3completedstarted 2020, after this paper: background citation

A Randomized, Open-label Study of Dapagliflozin in Patients With or Without Type 2 Diabetes Admitted With Acute Heart Failure

Ran2020Enrolled240Registered outcomes3Posted comparisons0ConditionsDiabetes Mellitus, Type 2, Heart FailureArmsDapagliflozin 10 mg, Protocolized Diuretic Therapy
PMID 27266853PMID 26299229PMID 26041600PMID 25838436PMID 25287144PMID 24879974PMID 24585267PMID 24247300PMID 23356556PMID 23333145PMID 23141816PMID 21732835other papers from this trial
Open the trial in the graph
3 · Its place in the literature

Who cites it

142 citing papers in PubMed, 3 syntheses or guidelines pooled it, 283 citations in OpenAlex.

  1. Pooled it
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  3. Acetazolamide as an Adjunctive Diuretic Therapy for Patients with Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2024 · on this map
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  8. Spot urinary sodium in acute decompensation of advanced heart failure and dilutional hyponatremia: insights from DRAIN trial.Clinical research in cardiology : official journal of the German Cardiac Society · 2020
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  15. Early treatment with tolvaptan improves diuretic response in acute heart failure with renal dysfunction.Clinical research in cardiology : official journal of the German Cardiac Society · 2017
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  19. Furosemide Stress Test and Biomarkers for the Prediction of AKI Severity.Journal of the American Society of Nephrology : JASN · 2015
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82 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Jeffrey M TestaniDepartment of Internal Medicine.
Meredith A Brisco
Jeffrey M Turner
Erica S Spatz
Lavanya Bellumkonda
Chirag R Parikh
W H Wilson Tang
Medical University of South Carolina · US

Funding

Mentoring Program for Translational and Patient Oriented Research in AKIK24DK090203 · NIDDK · YALE UNIVERSITY · PI PARIKH, CHIRAG R · 2012 to 2016
$896k
Cardio-renal phenotype and prognosis in chronic heart failureK23HL114868 · NHLBI · YALE UNIVERSITY · PI TESTANI, JEFFREY M · 2012 to 2017
$845k
NHLBI NIH HHS 1K23HL114868NHLBI NIH HHS K23 HL114868NHLBI NIH HHS L30 HL115790NHLBI NIH HHS L30HL115790NIDDK NIH HHS K24 DK090203NIDDK NIH HHS K24DK090203
6 · The paper itself

Abstract

backgroundRather than the absolute dose of diuretic or urine output, the primary signal of interest when evaluating diuretic responsiveness is the efficiency with which the kidneys can produce urine after a given dose of diuretic. As a result, we hypothesized that a metric of diuretic efficiency (DE) would capture distinct prognostic information beyond that of raw fluid output or diuretic dose. METHODS AND

resultsWe independently analyzed 2 cohorts: (1) consecutive admissions at the University of Pennsylvania (Penn) with a primary discharge diagnosis of heart failure (n=657) and (2) patients in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) data set (n=390). DE was estimated as the net fluid output produced per 40 mg of furosemide equivalents, then dichotomized into high versus low DE based on the median value. There was only a moderate correlation between DE and both intravenous diuretic dose and net fluid output (r(2)≤0.26 for all comparisons), indicating that DE was describing unique information. With the exception of metrics of renal function and preadmission diuretic therapy, traditional baseline characteristics, including right heart catheterization variables, were not consistently associated with DE. Low DE was associated with worsened survival even after adjusting for in-hospital diuretic dose, fluid output, in addition to baseline characteristics (Penn: hazards ratio [HR], 1.36; 95% confidence interval [CI], 1.04-1.78; P=0.02; ESCAPE: HR, 2.86; 95% CI, 1.53-5.36; P=0.001).

conclusionsAlthough in need of validation in less-selected populations, low DE during decongestive therapy portends poorer long-term outcomes above and beyond traditional prognostic factors in patients hospitalized with decompensated heart failure.

Indexed as

Acute DiseaseCause of DeathDiuresisDose-Response Relationship, DrugFemaleFollow-Up StudiesGlomerular Filtration RateHeart FailureHospital MortalityHumansInjections, IntravenousMaleMiddle AgedPatient DischargePennsylvaniaPrognosisSodium Potassium Chloride Symporter Inhibitorscardio-renal syndromediuresisdiureticheart failuresurvival

Identifiers

PMID24379278
PMCPMC4386906
OpenAlexW2116825982

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.