Background: Diuresis is the mainstay of treatment during hospitalization for patients admitted with congestive heart failure (CHF). Hospital length of stay (LOS) is considered an important patient outcome for CHF patients; previous studies comparing higher rates of diuresis (aggressive) versus relatively lower rates (nonaggressive) on patient outcomes have shown contradicting results. In fact, no specific guidelines to direct diuretic therapy exist. This investigation was designed to study the effect of early aggressive diuresis on hospital LOS.
Methods: Data from 194 CHF patients (admitted to the hospital for 1 year) were collected and analyzed in a retrospective cohort study design. Patients were divided into two cohorts based on urine output achieved in the first 24 h of admission; the aggressive diuresis cohort (urine output ≥2400 mL) comprised of 29 subjects while the nonaggressive diuresis cohort (urine output ≤2400 mL) had 165 subjects. The primary endpoint was LOS.
Results: Median LOS for the aggressive diuresis cohort was 4 days (95% confidence interval [CI]: 2.95-5.06) as compared to 5 days (95% CI 4.40-5.60) for the nonaggressive diuresis cohort; log-rank test showed no significant differences between the hospitalized proportions between the two cohorts over time ( = 0.67).
Conclusion: Hospital LOS for CHF patients treated with early aggressive diuresis was not significantly different compared to patients treated with nonaggressive diuresis.
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http://dx.doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_24_20 | DOI Listing |
J Hosp Med
November 2024
Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Diuresis for hospitalized patients with acute decompensated heart failure is a routine clinical practice but one that remains reliant on error-prone and resource-intensive intake and output and weight measurements and is subject to wide provider variation. We sought to use quality improvement approaches to implement a data-driven predictive diuresis protocol based on natriuresis using the electronic health record to titrate dosing. Our initiative did not result in significant reductions in length of stay but did demonstrate a significant increase in the use of urine studies to guide diuresis and signals toward more aggressive diuretic dosing without an increase in adverse outcomes.
View Article and Find Full Text PDFJ Exp Biol
October 2024
Department of Biology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
Insects such as the model organism Drosophila melanogaster must modulate their internal physiology to withstand changes in temperature and availability of water and food. Regulation of the excretory system by peptidergic hormones is one mechanism by which insects maintain their internal homeostasis. Tachykinins are a family of neuropeptides that have been shown to stimulate fluid secretion from the Malpighian 'renal' tubules (MTs) in some insect species, but it is unclear if that is the case in the fruit fly, D.
View Article and Find Full Text PDFFront Nephrol
August 2024
Hematology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
Psychiatry Clin Neurosci
September 2024
Department of Endocrinology, Georgetown University, Washington, District of Columbia, USA.
Vasopressin or arginine-vasopressin (AVP) is a neuropeptide molecule known for its antidiuretic effects and serves to regulate plasma osmolality and blood pressure. The existing literature suggests that AVP plays a multifaceted-though less well-known-role in the central nervous system (CNS), particularly in relation to the pathophysiology and treatment of mood disorders. Animal models have demonstrated that AVP is implicated in regulating social cognition, affiliative and prosocial behaviors, and aggression, often in conjunction with oxytocin.
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