The Effect of Furosemide Dose Administered in the Out-of-hospital Setting on Renal Function Among Patients with Suspected Acute Decompensated Heart Failure

Prehosp Disaster Med. 2015 Feb;30(1):38-45. doi: 10.1017/S1049023X14001411. Epub 2015 Jan 16.


Background: The most effective dose of prehospital furosemide in acute decompensated heart failure (ADHF) has not yet been identified and concerns of worsening renal function have limited its use.

Objective: To assess if administering high-dose furosemide is associated with worsening renal function.

Methods: The authors conducted a 2-center chart review for patients who presented via a single Emergency Medical Service (EMS) from June 5, 2009 through May 17, 2013. Inclusion criteria were shortness of breath, primarily coded as ADHF, and the administration of furosemide prior to emergency department (ED) arrival. A total of 331 charts were identified. The primary endpoint was an increase in creatinine (Cr) of more than 0.3 mg/dL from admission to any time during hospital stay. Exploratory endpoints included survival, length-of-stay (LOS), disposition, urine output in the ED, change in BUN/Cr from admission to discharge, and change in Cr from admission to 72 hours and discharge.

Results: When treated as a binary variable, there was no association observed between an increase in Cr of more than 0.3 mg/dL and prehospital furosemide dose. Baseline characteristics found to be associated with dose were included in the logistic regression model. Lowering the dose of prehospital furosemide was associated with higher odds of attaining a 0.3 mg/dL increase in Cr (adjusted OR = 1.49 for a 20 mg decrease; P = .019). There was no association found with any of the exploratory endpoints.

Conclusions: Patients who received higher doses of furosemide prehospitally were less likely to have an increase of greater than 0.3 mg/dL in Cr during the hospital course.

Keywords: ADHF acute decompensated heart failure; ALS Advanced Life Support; BLS Basic Life Support; CCI Charlson Comorbidity Index; Cr creatinine; DOSE Diuretic Optimization Strategies Evaluation; ED emergency department; EMS Emergency Medical Services; IV intravenous; LOS length-of-stay; prehospital.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Biomarkers / urine
  • Blood Urea Nitrogen
  • Comorbidity
  • Creatinine / urine
  • Diuretics / administration & dosage*
  • Dose-Response Relationship, Drug
  • Emergency Treatment*
  • Female
  • Furosemide / administration & dosage*
  • Heart Failure / drug therapy*
  • Humans
  • Kidney / drug effects*
  • Kidney Function Tests
  • Length of Stay / statistics & numerical data
  • Male
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome


  • Biomarkers
  • Diuretics
  • Furosemide
  • Creatinine