Ultrasound Assessment of Kidney Volume in Patients with Acute Decompensated Heart Failure: A Predictor of Diuretic Resistance

Background Diuretics are essential for treating acute decompensated heart failure (ADHF), but the response is inconsistent. This study aimed to clarify whether kidney volume as assessed by ultrasound (US) predicts diuretic resistance in patients with ADHF. Methods We enrolled 29 patients with ADHF and 32 controls. Height-adjusted kidney volume was assessed by US. We divided patients into two groups based on the median value of total daily use of furosemide (intravenous dose plus 0.5 x oral dose of furosemide equivalents) during 3 days from admission. Results Patients with ADHF had a significantly smaller left kidney volume than did control subjects (27.7 +/- 10.0 vs. 32.8 +/- 8.8 mL/m, P < 0.05). Patients in the high-dose furosemide group (>= 51.7 mg/d) had a significantly lower estimated glomerular filtration rate (eGFR) and a significantly smaller kidney volume than did those in the low-dose furosemide group (eGFR: 43.9 +/- 20.4 vs. 60.8 +/- 21.6 mL/min/1.73 m(2), left kidney volume: 23.2 +/- 5.2 vs. 32.6 +/- 11.0 mL/m, right kidney volume: 26.5 +/- 7.5 vs. 32.6 +/- 7.9 mL/m, all P < 0.05). Multivariate logistic analysis showed that left kidney volume, but not eGFR, was independently associated with the requirement of high-dose furosemide (odds ratio: 0.856, 95% confidence interval: 0.735-0.997, P < 0.05). Conclusion Kidney volume as assessed by US is a useful predictor of diuretic resistance in patients with ADHF.