Obesity and the response to intensified diuretic treatment in decompensated heart failure: A DOSE trial substudy

Achal Gupta, Eugene Braunwald, Steven McNulty, G. Michael Felker, E. Michael Gilbert, Rami Alharethi, Kerry L. Lee, Kevin J. Anstrom, Margaret M. Redfield, Steven Goldsmith, Christopher M. O'Connor, David A. Bull, Josef Stehlik, Sheldon E. Litwin

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13 Scopus citations


Background: Obesity could attenuate diuretic effectiveness in treatment of acute decompensated heart failure (HF). Methods and Results: The DOSE trial randomized 308 subjects with acute HF to low- versus high-intensification intravenous diuretic therapy. We tested for statistical interactions between obesity and dosing strategy across clinical end points. After 72 hours of treatment, obese subjects (body mass index >30 kg/m2; n = 173) had greater volume loss than nonobese subjects (n = 119) but similar improvements in dyspnea and freedom from congestion. Both groups had greater fluid loss with high-intensification treatment. Obese subjects had a higher incidence of worsening renal function (WRF) at 72 hours with low-intensification treatment, compared with nonobese subjects. In contrast, nonobese and obese subjects had similar incidence of WRF with high-intensification treatment. There were no differences between obese and nonobese subjects in time to discharge and 60-day freedom from death, emergency department visit, or rehospitalization. Conclusions: The incidence of WRF was greater in obese than in nonobese subjects with low-intensification treatment. However, the frequency of WRF was equivalent in obese and nonobese subjects with high-intensification treatment. Additional studies are needed to assess whether obese patients with acute HF benefit from an initial high-intensification treatment strategy.

Original languageEnglish (US)
Pages (from-to)837-844
Number of pages8
JournalJournal of cardiac failure
Issue number11
StatePublished - Nov 2012


  • Obesity
  • congestive heart failure
  • diuretics
  • readmission
  • renal function


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