Bumetanide vs. Furosemide in Cirrhosis

Phase

Condition

Liver Disorders

Scar Tissue

Hepatic Fibrosis

Treatment

Furosemide

Bumetanide

Clinical Study ID

NCT06941415

IRB_00186841

Ages > 18
All Genders

Study Summary

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.

Eligibility Criteria

Inclusion

Inclusion Criteria:

History of liver cirrhosis
Clinician placed an order for bumetanide or furosemide in electronic health recordwithin 24 hours of presentation to the hospital

Exclusion

Exclusion Criteria:

Allergy to bumetanide or furosemide
Contraindication to diuretic administration (e.g. active bleeding, clinicalsuspicion of hepatorenal syndrome, hypotension)
Incarcerated or in custody of law enforcement
Diuretic ordered for purpose other than volume overload (e.g. hyperkalemia,continuation of home medication without clinical signs of volume overload)
Inpatient admission not anticipated
Not admitted to an inpatient hospital bed following initial evaluation in theemergency department

Study Design