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Risks and benefits of urinary catheterisation during inpatient diuretic therapy for acute heart failure: a

Gregor John1,2,3, Marc Arcens3, Gregory Berra3

  • 1Department of Medicine, Université de Genève, Geneva, Switzerland gregor.john@rhne.ch.

BMJ Open
|May 2, 2023
PubMed

Insights

Urinary catheterisation (UC) in acute congestive heart failure patients did not improve weight loss during diuretic therapy. UC increased urinary tract infection (UTI) risk without offering clinical benefits, suggesting it should not be systematically used.

Area of Science:

  • Cardiology
  • Nephrology
  • Infectious Diseases

Background:

  • Patients with acute congestive heart failure (HF) often receive urinary catheterisation (UC) upon hospital admission.
  • The clinical utility and potential risks of UC in this population remain subjects of investigation.

Purpose of the Study:

  • To evaluate the clinical benefits of UC regarding weight loss in acute congestive HF patients undergoing diuretic therapy.
  • To assess the impact of UC on the risk of urinary tract infection (UTI) and other clinical outcomes.

Main Methods:

  • A retrospective, non-inferiority study compared 113 catheterised HF patients with 346 non-catheterised patients within 24 hours of diuretic therapy.
  • Primary endpoint: weight loss at 48 hours. Secondary endpoints: time to target weight, diuretic discontinuation, respiratory failure resolution, UTI, readmission, and mortality.

Main Results:

  • Weight loss at 48 hours was not statistically different between groups (adjusted difference: 0.43 kg, favoring UC, p<0.01 for non-inferiority).
  • UC did not significantly impact time to target weight, diuretic discontinuation, or respiratory failure resolution.
  • UC significantly increased UTI risk (aHR 2.5) but showed no association with readmission or 1-year mortality.

Conclusions:

  • Urinary catheterisation within 24 hours of initiating diuretic treatment for acute congestive HF offers no significant clinical benefit in terms of weight loss or clinical improvement.
  • UC is associated with an increased risk of urinary tract infections.
  • The findings argue against the routine, systematic use of urinary catheterisation in patients with acute congestive heart failure receiving diuretic therapy.
Abstract

Keywords:
health & safetyheart failureurinary tract infections

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