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Chronological Changes and Correlates of Loop Diuretic Dose in Left Ventricular Assist Device Patients.

Kido, Kazuhiko Pharm.D.,MS; George, Bennet M.D.; Charnigo, Richard J. Ph.D.; Macaulay, Tracy E. Pharm.D.; Brouse, Sara D. Pharm.D.; Guglin, Maya M.D., Ph.D.
doi: 10.1097/MAT.0000000000000565
Original Article: PDF Only

No study has systematically evaluated the prevalence and dosages of diuretic use for patients after left ventricular assist device (LVAD) implantation. The primary objective was to characterize chronological change in prevalence and doses of loop diuretics after LVAD placement. The secondary objective was to identify correlates of actual doses of loop diuretics. We retrospectively reviewed medical records of adult patients with LVAD implantation at the University of Kentucky. Prevalence of diuretic use and furosemide equivalent dose were assessed before LVAD implantation and at seven time points thereafter: 1 week, 1 month, 3 months, 6 months, 1 year, 18 months, and 2 years. Correlation analyses and linear mixed modeling were used to identify correlates of diuretic dose before and after LVAD implantation. Eighty two consecutive eligible patients were reviewed. The prevalence of loop diuretic use was 95% at baseline but significantly lower than that at all subsequent time points (p < 0.048 for all). Nevertheless, more than half of patients on whom we had such follow-up data were on loop diuretics two years after LVAD implantation. Average furosemide equivalent dose was significantly lower at every time point after implantation compared to baseline (p < 0.006 for all). Blood urine nitrogen (BUN) was the most robust predictor of dose after LVAD implant. The prevalence and average furosemide equivalent dose was significantly reduced after LVAD implantation, but the use of loop diuretic remained more than 50% for up to two years. Consistent association with BUN may indirectly indicate overuse of diuretics post LVAD implant.

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