Relationship between clinical congestion and worsening renal function after intravenous initiation of furosemide in patients with acute heart failure

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This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI18/00393 and co-funded by the European Union. The ICA-Research Group has received unrestricted funding from Novartis and Orion Pharma. We appreciate the high pro-fessionalism of Alicia Diaz in the data management of the EAHFE Registry. The design of the study, patient inclusion, data analysis, discussion and final conclusions were exclusively carried out by the authors with no participation of the granters

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Aguilo, SiraAuthorFuentes Prado, MireyaAuthorEspinosa, BegoñaAuthorGil, VictorAuthorEscoda, RosaAuthorMiro, OscarCorresponding Author

November 12, 2024

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Article

Publicated to:Internal And Emergency Medicine. 20 (5): 1553-1564 - 2025-08-01 20(5), DOI: 10.1007/s11739-024-03796-0

Authors: Espinosa B; Llauger L; Gil V; Escoda R; Jacob J; Aguirre A; Mojarro EM; Tost J; Alquézar-Arbé A; López-Grima ML; Millán J; Massó M; Cuquerella GS; Pagán F; Núñez J; Dauw J; Müllens W; Llorens P; Miró Ò

Affiliations

AZ Sint Lucas, Dept Cardiol, Ghent, Belgium - Author

Consorci Sanitari Terrassa, Emergency Dept, Terrassa, Catalonia, Spain - Author

Hosp Doctor Peset, Emergency Dept, Valencia, Spain - Author

Hosp La Santa Creu & St Pau, Emergency Dept, Barcelona, Catalonia, Spain - Author

Hosp Mar, Emergency Dept, Barcelona, Catalonia, Spain - Author

Hosp Politecn La Fe, Emergency Dept, Valencia, Spain - Author

Hosp Rey Juan Carlos I, Emergency Dept, Madrid, Spain - Author

Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain - Author

Hosp Univ Mutua Terrassa, Dept Gastroenterol, Barcelona, Catalonia, Spain - Author

Hosp Univ Vic, Emergency Dept, Barcelona, Catalonia, Spain - Author

Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Emergency Dept, C Villarroel 170, Barcelona 08036, Catalonia, Spain - Author

Univ Hosp Basel, Dept Cardiol, Cardiovasc Res Inst Basel, Basel, Switzerland - Author

Univ Miguel Hernandez, Hosp Gen Alicante, Hospitalizat Home Unit, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Alicante, Spain - Author

Univ Miguel Hernandez, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Short Stay Unit, Hosp Gen Alicante,Emergency Dept, Alicante, Spain - Author

Univ Valencia, Hosp Clin Valencia, Cardiol Dept, INCLIVA, Valencia, Spain - Author

Abstract

To investigate if worsening renal function (WRF) appearing in some patients with acute heart failure (AHF) after intravenous furosemide initiation is influenced by severity of congestion. We conducted a retrospective secondary analysis of consecutive patients diagnosed with AHF and prospectively included in 10 Spanish emergency departments (EDs) for whom serum creatinine at ED arrival and after 2-7 days of intravenous furosemide initiation were available. Congestion was clinically evaluated by identification of 7 signs/symptoms and by chest X-ray. The outcome was WRF, defined as a delta-creatinine >= 0.3 mg/dL. Risk of WRF according to congestion was estimated in models adjusted by patient baseline characteristics and vitals at ED arrival, and interaction was also investigated. We included 3027 patients (median age 82 years, 56% women), and 657 (21.7%) presented WRF after intravenous furosemide initiation. When signs/symptoms were individually considered, only lower limbs edema was associated with decreased risk of WRF (20.1% vs. 24.8%; OR = 0.76, 95%CI = 0.64-0.91). After adjustment, lower limbs edema persisted inversely associated with WRF (aOR = 0.78, 95%CI = 0.65-0.94), with significant lower risk for patients 80 years), dementia, heart valve disease and NYHA class III-IV were associated with higher mortality. Intravenous furosemide initiation in patients with AHF without lower limbs edema must be cautious, as they are at increasing risk of developing WRF during the next following days, which in turn is associated with a higher 1-year mortality.

Keywords

Acute diseaseAcute heart failureAdministration, intravenousAgedAged, 80 and overBlood-pressureCongestionCreatinineDischargeDiureticsEdemaEmergency-departmentFemaleFurosemidFurosemideHeart failureHospitalizationHumansLower limb edemaMaleManagementMortalityRetrospective studiesSafetSpainWorsening renal function

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Internal And Emergency Medicine due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2025, it was in position 50/332, thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine, General & Internal.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-09-10:

Europe PMC: 1

Impact and social visibility

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Belgium; Switzerland.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Espinosa Fernández, Begoña) and Last Author (Miró Andreu, Òscar).