Patients with cirrhosis are frequently hospitalized due to an acute decompensation of their liver disease including bleeding, jaundice, encephalopathy, and volume overload. Volume overload is associated with increased mortality from acute hypoxic respiratory failure, hemorrhage from esophageal varices, and spontaneous bacterial peritonitis. Clinical practice guidelines describe sodium restriction and diuretics as first-line treatment, combined with regular body weight monitoring to assess response. In patients with suboptimal response to furosemide, alternative loop diuretics like torsemide or bumetanide may improve natriuresis. Bumetanide has a theoretic advantage over furosemide due to its more rapid and complete intestinal absorption, combined with a prolonged half-life in patients with hepatic dysfunction. In this pragmatic study, the aim is to compare the efficacy of diuresis with bumetanide versus furosemide among hospitalized patients with cirrhosis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
500
Standard of care treatment with bumetanide (intravenous or oral administration) per treating clinician's orders
Standard of care treatment with furosemide (intravenous or oral administration) per treating clinician's orders
University of Utah Hospital
Salt Lake City, Utah, United States
Percent change in weight
Percent change in weight measured in kilograms from date of emergency department presentation (Day 0) to Day 7 of hospitalization, or date of discharge, whichever is earlier
Time frame: 7 days
Development of acute kidney injury
Stage 2 or higher acute kidney injury developing within 14 days of presentation to emergency department in accordance with KDIGO criteria
Time frame: 14 days
Need for replacement therapy
New initiation of intermittent or continuous hemodialysis within 14 days of presentation to the emergency department
Time frame: 14 days
Severe electrolyte derangement
New decrease in serum potassium to less than 2.5 mEq/L within 14 days of presentation to the emergency department
Time frame: 14 days
Hospital length of stay
Time from initial presentation to the emergency department to the time of discharge from the hospital or time of death, if a subject dies within the hospital
Time frame: 30 days
Unplanned hospital readmission
Readmission to the hospital for an unexpected reason within 30 days of a prior hospital admission
Time frame: 30 days
30-day mortality
Death occurring within the 30 days following presentation to the emergency department and subsequent hospital admission
Time frame: 30 days
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