• Soumya G K Pharm.D, Department of Pharmacy Practice, PSG College of Pharmacy
  • DR. Prudence A Rodrigues M. Pharm, PhD, Department of Pharmacy Practice, PSG College of Pharmacy
  • Nadia Grace Bunshaw Pharm.D, Department of Pharmacy Practice, PSG College of Pharmacy
  • Saranya N Pharm.D, Department of Pharmacy Practice, PSG College of Pharmacy
  • Sujith K Pharm.D, Department of Pharmacy Practice, PSG College of Pharmacy
  • Dr. R Shanmuga Sundaram MD, DM, Department of Cardiology, PSG IMS & R




Objective: To monitor the impact of loop diuretic therapy in patients with Acute Decompensated Heart Failure (ADHF) and to assess other predictors of  renal dysfunction in patients with ADHF.


Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the department of Cardiology, in a tertiary care teaching hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded. The patients were evaluated based on the change in serum creatinine and other contributing factors were assessed by Acute Kidney Injury Network (AKIN) and Worsening of Renal Function (WRF) criteria.


Results: A total of 135 patients were enrolled, out of which 73% were males and 27% were females. The mean age of the subjects was 61.55 ± 13 years. The baseline mean serum creatinine was 1.62±0.92mg/dl. On evaluation, 41% were renally affected and 59% remain unaffected. Factors like Hypertension (p = 0.047) and ACE-I (p = 0.023) were found to be significant predictors of renal injury.


Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present, but was not well established. Hypertension and Angiotensin Converting Enzyme Inhibitors (ACE-I) showed influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

Keywords: ADHF, Loop diuretcs, Renal dysfunction, Serum creatinine


1. Meyer TE. Approach to acute decompensated heart failure in adults. UpToDate, Post, TW (Ed), UpToDate, Waltham, MA. 2019.
2. Han SW, Ryu KH. Renal dysfunction in acute heart failure. Korean Circ J. 2011 Oct;41(10):565-74.
3. Shirakabe A, Hata N, Kobayashi N, Shinada T, Tomita K, Tsurumi M, et al. Prognostic impact of acute kidney injury in patients with acute decompensated heart failure. Circ J. 2013;77(3):687-96.
4. Damman K, Navis G, Smilde TD, Voors AA, van der Bij W, van Veldhuisen DJ et al. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail. 2007 Sep;9(9):872-8.
5. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797-805.
6. Felker GM, O'Connor CM, Braunwald E. Loop diuretics in acute decompensated heart failure: necessary? Evil? A necessary evil?. Circ Heart Fail. 2009 Jan;2(1):56-62.
7. Peacock WF, Costanzo MR, De Marco T, Lopatin M, Wynne J, Mills RM, et al. Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: insights from the ADHERE registry. Cardiology. 2009;113(1):12-9.
8. Krumholz HM, Chen YT, Vaccarino V, Wang Y, Radford MJ, Bradford WD, et al. Correlates and impact on outcomes of worsening renal function in patients? 65 years of age with heart failure. Am J Cardiol. 2000 May 1;85(9):1110-3.
9. Roy AK, Mc Gorrian C, Treacy C, Kavanaugh E, Brennan A, Mahon NG, et al. A comparison of traditional and novel definitions (RIFLE, AKIN, and KDIGO) of acute kidney injury for the prediction of outcomes in acute decompensated heart failure. Cardiorenal Med. 2013 Apr;3(1):26-37.
10. Kalra OP, Aggarwal A. Rational use of diuretics and pathophysiology of edema. Medicine. 2012;22.
11. Damman K, Kjekshus J, Wikstrand J, Cleland JG, Komajda M, Wedel H, et al. Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction. Eur J Heart Fail. 2016 Mar;18(3):328-36.
12. Onuigbo M, Agbasi N, Sengodan M, Rosario K. Acute kidney injury in heart failure revisited—the ameliorating impact of “decongestive diuresis” on renal dysfunction in type 1 acute cardiorenal syndrome: accelerated rising Pro B natriuretic peptide is a predictor of good renal prognosis. J Clin Med. 2017 Aug 29;6(9).
13. Mostafa El-Refai, Olesya Krivospitskaya, Edward L. Peterson, Karen Wells, L. Keoki Williams, and David E. Lanfear Relationship of loop diuretic dosing and acute changes in renal function during hospitalization for heart failure. J Clin Exp Cardiolog. 2011 Nov 22; 2(10): 1000164
14. Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014 Feb;35(7):455-69.
15. Al-Naher A, Wright D, Devonald MAJ, Pirmohamed M. Renal function monitoring in heart failure–what is the optimal frequency? A narrative review. Br J Clin Pharmacol. 2018 Jan;84(1):5-17.
16. Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R, et al. Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance. Eur J Heart Fail. 2008 Feb;10(2):188-95.
17. Ahmed A, Campbell RC. Epidemiology of chronic kidney disease in heart failure. Heart Fail Clin. 2008 Oct; 4(4): 387–399.
18. Schmidt M, Mansfield KE, Bhaskaran K, Nitsch D, Sørensen HT, Smeeth L, et al. Serum creatinine elevation after renin-angiotensin system blockade and long term cardiorenal risks: cohort study. BMJ. 2017; 356: j791.
11 Views | Downloads
How to Cite
G K, S., P. A. Rodrigues, N. G. Bunshaw, S. N, S. K, and S. S. R. “ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETIC IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 12, no. 12, Oct. 2019,
Original Article(s)