| Objectives:This study is to investigate the characteristics of the diuretic application in the recent 30 years,impact of loop diuretics on electrolyte balance and renal function,correlation of different loop diuretic dosage and diuretic category to in-hospital mortality of patients with CHF,in order to demonstrate a efficient clinical application of diuretics which can make CHF patients acquire more benefits.Methods:The study subjects enrolled 2555 patients with CHF came from Department of cardiology in second hospital of Tian Jin Medical university from Jan 1980 to Aug 2007,using retrospective case analysis.Detailed clinical information was collected,including baseline demographics,physical examination,etiology,laboratory results,pharmaceutical treatment and prognosis,et al.The data were divided into different groups according to the age,gender,cardiac function classification,etiology,decades,equivalent daily loop diuretic dosage and whether combining potassium-sparing diuretic therapy.All the data were analyzed and compared respectively.Results:1.2458 cases were enrolled,among which there were 1660 patients used diuretics(67.5%).Loop diuretics were the most commonly prescribed diuretics (64.0%)followed by spironolactone(44.0%)and thiazide diuretics(16.3%).There were 32.1%patients received two or more diuretics therapy Most common combination is a loop diuretic and spironolactone(25.4%).2.Analyzed according to decades,Diuretics still dominated the major pharmaceutical application in clinical heart failure therapy,especially in patients with Heart Failure of New York Heart Association classⅣ,rheumatic heart disease and dilated cardiomyopathy.The usage frequencies were all high in different decades(61.2%vs 71.0%vs 66.5%),among which aldosteron blocker application increased essentially(22.7%,25.8%,33.9%, P＜0.001).The combination drug application,including ACEI,β-blocker with diuretic also increased by decades.The in-hospital mortality rates of CHF decreased significantly after year 2000(9.5%vs 8.9%vs 5.3%,P＜0.01)and the admission time(median25,13,11,P＜0.01)were shorter with decades.3.Analyzed according to daily loop diuretic dosage:①The highest quartile was associated with a smaller age,lower ejection fraction and serum blood pressure,also lower serum sodium, serum potassium,albumin and hemoglobin levels but higher serum urea nitrogen and creatinine levels.There was higher ratio of rheumatic heart disease and lower ratio of coronary heart disease in the highest quartile than the lowest.②There was an increasing tendency in the incidence of hyponatremia and hypokalemia with increasing loop diuretic dosage(2.9%,9.5%,13.3%,21.9%,P＜0.001 and 4.8%,13.3%,16.7%,20.7%,P＜0.001,respectively).Large dosage of Loop diuretic was an independent predictor of the incidence of hyponatremia and hypokalemia in-hospital. The risk of in-hospital hyponatremia and hypokalemia increased by 1.521(OR=2.521,P＜0.001)and 0.448(OR=1.488,P＜0.001)respectively for each 40 mg increasing of loop diuretic dose.③Discharge Bun and Bun/Cr level of the＞80mg dosage group were increased significantly compared to admission level,both P＜0.01.But discharge Bun,Cr and Bun/Cr level of the control group were descended compared to admission level with statistically differences.④There was an increasing in-hospital mortality of CHF with increasing loop diuretic dosage(5.8%vs. 7.3%vs.8.7%vs.20.5%).Compared with the other three groups,＞80mg dosage group all had statistically meanings while no statistically differences in the other three groups.After adjusting to other risk factors with multivariable logistic regression analysis,Loop diuretic dosage＞80mg was an independent predictor of in-hospital mortality of CHF patients.The risk of in-hospital mortality increased by 59.3%for loop diuretic dosage＞80 mg/d(P＜0.037,OR=1.593).⑤The admission time was longer by the increasing of loop diuretic dosage(10,13,14,16.5,P＜0.001).Even after co-variants adjusting with multivariable liner regression analysis,daily loop diuretic dosage,age,creatinine,serum sodium,course of CHF were independent factors of CHF patients to admission time.There was most significant correlation between the loop diuretic dosage and admission time(Beta=0.181,t=7.175,P＜0.001). 4.According to different groups of diuretics types,compared no-taking diuretic and taking-both-types of diuretic group,in-hospital mortality was increased with NPSD (15.1%vs 6.9%vs 5.8%,P=0.001).Although the patients in taking-both-types of diuretic group seemed severe than no-taking diuretic,there was no statistically difference in these two groups.There were no statistically differences in the incidence of hyperkalemia in these three groups.Conclusions:Diuretics still dominated the major pharmaceutical application in clinical heart failure therapy and the usage frequencies were all high in different decades,especially in patients with Heart Failure of New York Heart Association classⅣ,rheumatic heart disease and dilated cardiomyopathy.The combination drug application,including ACEI,β-blocker with diuretic also increased by decades,but there was still a distance between clinical practice and guideline of CHF treatment. The incidence of these electrolyte abnormalities in hospital is directly related to the dosage of diuretic.High dosage diuretic may be considered an independent indicator of in-hospital mortality and longer admission time in patients with CHF.Compared to no-taking diuretic and taking-both-types of diuretic group,in hospital mortality were increased with NPSD.Although the patients in taking-both-types of diuretic group seemed severe than no-taking diuretic group,there was no statistically difference in mortality proportion of two groups,which imply that taking PSD with loop diuretic may decrease in hospital mortality of patients with CHF.In clinical,we should use diuretics on rule and improve the combination drug application with ACEI andβ-blocker.
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