Sun et al identified risk factors for acute renal insufficiency developing in a patient treated with diuretics for congestive heart failure (CHF). These can help to identify a patient who may benefit from more aggressive management. The authors are from the Brookdale University Hospital and Medical Center in Brooklyn.


Patient selection: congestive heart failure receiving diuretic therapy


Acute renal insufficiency was defined as a 25% increase in the serum creatinine.


Risk factors at baseline associated with development of acute renal insufficiency:

(1) older age (>= 68 years of age)

(2) serum sodium <= 138 mmol/L

(3) presence of systolic dysfunction

(4) high dose furosemide therapy

(5) prolonged therapy with furosemide (7 or more days)

(6) higher baseline serum creatinine (>= 1.7 mg/dL)

(7) lower mean arterial pressure (< 94 mm Hg)


Factors associated with a reduced risk:

(1) therapy with digoxin in a patient with systolic dysfunction


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