United States – October 29, 2026 -- High-dose loop diuretics combined with adjuvant therapy produced an adjusted average weight loss of 4.6 pounds in heart failure inpatients, the largest of any strategy, but also came with higher rates of acute kidney injury, according to a study in the Journal of Cardiac Failure.
Study tracks 109,000 heart failure patients across US health systems
Researchers used Truveta Data to identify more than 109,000 patients hospitalized for heart failure between 2015 and 2022. Patients were grouped by the most intensive diuretic strategy used within the first 48 hours, ranging from low-dose loop diuretics alone to high-dose loop diuretics combined with thiazides or acetazolamide.
The team measured weight loss, hemoconcentration, in-hospital acute kidney injury, and the combined outcome of readmission or death within 90 days.
More aggressive regimens remove more fluid but raise kidney injury rates
Patients on more intensive strategies lost more weight during hospitalization, indicating more effective fluid removal. They also had higher rates of acute kidney injury, a clinical tradeoff of aggressive decongestion.
Intensive treatment does not lower 90-day readmission or death odds
More intensive diuretic strategies were not associated with lower odds of readmission or death within 90 days, despite the greater weight loss.
Weight loss itself was linked to outcomes. Patients who lost more weight during hospitalization had lower odds of readmission or death within 90 days, and every five pounds lost was associated with lower adjusted odds of the combined outcome. The relationship held across treatment groups, regardless of how the weight loss was achieved.
The analysis is based on the TREAT-AHF Registry and is titled "Initial Diuretic Strategy During Hospitalization for Heart Failure and Associated Outcomes."