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loop diuretics and renal insufficiency

Mayank K Mittal, Natraj Katta, Martin A Alpert
Chronic congestive heart failure (CHF) and acute decompensated heart failure (ADHF) refractory to medical therapy represent therapeutic challenges. In such patients, attempts to reduce pulmonary and systemic congestion frequently produce deterioration of renal function. In studies of patients with chronic severe CHF refractory to medical therapy (including loop diuretics), isolated ultrafiltration was frequently able to relieve congestive symptoms by precise removal of extracellular water and sodium, and in some cases was able to restore responsiveness to loop diuretics...
October 2016: Hemodialysis International
Tomoko S Kato, Shunya Ono, Kan Kajimoto, Kenji Kuwaki, Taira Yamamoto, Atsushi Amano
BACKGROUND: Renal failure is a serious complication after cardiac surgery, which can be caused by long-term intravenous (IV) loop diuretic use. Tolvaptan is an oral selective vasopressin-2 receptor antagonist used in patients irresponsive to loop diuretics. We investigated their renal perfusion changes using the resistive index (RI) postoperatively. METHODS: Serial renal RI, echocardiography, and laboratory examinations from 14 patients requiring continuous postoperative IV loop diuretics were reviewed...
2015: Journal of Cardiothoracic Surgery
G Michael Felker, Robert J Mentz, Kirkwood F Adams, Robert T Cole, Gregory F Egnaczyk, Chetan B Patel, Mona Fiuzat, Douglas Gregory, Patricia Wedge, Christopher M O'Connor, James E Udelson, Marvin A Konstam
Congestion is a primary reason for hospitalization in patients with acute heart failure (AHF). Despite inpatient diuretics and vasodilators targeting decongestion, persistent congestion is present in many AHF patients at discharge and more severe congestion is associated with increased morbidity and mortality. Moreover, hospitalized AHF patients may have renal insufficiency, hyponatremia, or an inadequate response to traditional diuretic therapy despite dose escalation. Current alternative treatment strategies to relieve congestion, such as ultrafiltration, may also result in renal dysfunction to a greater extent than medical therapy in certain AHF populations...
September 2015: Circulation. Heart Failure
Alberto Palazzuoli, Gaetano Ruocco, Claudio Ronco, Peter A McCullough
Current goals in the acute treatment of heart failure are focused on pulmonary and systemic decongestion with loop diuretics as the cornerstone of therapy. Despite rapid relief of symptoms in patients with acute decompensated heart failure, after intravenous use of loop diuretics, the use of these agents has been consistently associated with adverse events, including hypokalemia, azotemia, hypotension, and increased mortality. Two recent randomized trials have shown that continuous infusions of loop diuretics did not offer benefit but were associated with adverse events, including hyponatremia, prolonged hospital stay, and increased rate of readmissions...
2015: Critical Care: the Official Journal of the Critical Care Forum
Hall Schartum-Hansen, Kjetil H Løland, Gard F T Svingen, Reinhard Seifert, Eva R Pedersen, Jan E Nordrehaug, Øyvind Bleie, Marta Ebbing, Christ Berge, Dennis W T Nilsen, Ottar Nygård
BACKGROUND: Loop diuretics are widely used in patients with heart and renal failure, as well as to treat hypertension and peripheral edema. However, there are no randomized, controlled trials (RCT) evaluating their long term safety, and several observational reports have indicated adverse effects. We sought to evaluate the impact of loop diuretics on long term survival in patients with suspected coronary artery disease, but without clinical heart failure, reduced left ventricular ejection fraction or impaired renal function...
2015: PloS One
Naoto Tominaga, Keisuke Kida, Naoki Matsumoto, Yoshihiro J Akashi, Fumihiko Miyake, Kenjiro Kimura, Yugo Shibagaki
BACKGROUND: Treatment of congestive heart failure (CHF) with loop diuretics, such as furosemide, may be associated with complications, including worsening renal function and metabolic or electrolyte disturbances. Coadministration of tolvaptan, a selective vasopressin V2 receptor antagonist, can ameliorate such adverse events by reducing the required dose of loop diuretics; however, the safety of tolvaptan in patients with reduced renal function is not known. As a result, we conducted an exploratory clinical trial of tolvaptan in 22 patients with CHF and advanced chronic kidney disease (CKD)...
July 2015: Clinical Nephrology
Angel W Leung, Cherise Y Chan, Bryan P Yan, Cheuk Man Yu, Yat Yin Lam, Vivian W Lee
BACKGROUND: Heart failure (HF) is one of the most debilitating chronic illnesses. The prevalence is expected to increase due to aging population. The current study aimed to examine the management of heart failure with preserved ejection fraction (HFpEF) including drug use pattern, direct medical cost and humanistic outcome in a local public hospital in Hong Kong. METHODS: The current study adopted the retrospective observational study design. Subjects were recruited from the Heart Failure Registry of the Prince of Wales Hospital in Hong Kong between 2006 and 2008 and completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 3 designated time-points conferred eligibility...
2015: BMC Cardiovascular Disorders
Hans-Peter Brunner-La Rocca, Christian Knackstedt, Luc Eurlings, Vinzent Rolny, Friedemann Krause, Matthias E Pfisterer, Daniel Tobler, Peter Rickenbacher, Micha T Maeder
AIMS: Renal failure is a major challenge in treating heart failure (HF) patients. HF medication may deteriorate renal function, but the impact thereof on outcome is unknown. We investigated the effects of HF medication on worsening renal function (WRF) and the relationship to outcome. METHODS AND RESULTS: This post-hoc analysis of TIME-CHF (NT-proBNP-guided vs. symptom-guided management in chronic HF) included patients with LVEF ≤45% and ≥1 follow-up visit (n = 462)...
February 2015: European Journal of Heart Failure
Michael Sarai, Aaron M Tejani
BACKGROUND: Blood transfusions are associated with significant morbidity and mortality. Prophylactic administration of loop diuretics (furosemide, bumetanide, ethacrynic acid, or torsemide) is common practice, especially among people who are at risk for circulatory overload, pulmonary oedema or both. OBJECTIVES: This review aimed to determine if the prophylactic administration of loop diuretics (furosemide, bumetanide, ethacrynic acid, or torsemide) provides a therapeutic advantage (that is, a favourable risk benefit ratio) in adults and children who are recipients of any blood product transfusion versus placebo, no treatment, or general fluid restriction measures...
2015: Cochrane Database of Systematic Reviews
Laurent Becquemont, Bernard Bauduceau, Linda Benattar-Zibi, Gilles Berrut, Philippe Bertin, Sophie Bucher, Emmanuelle Corruble, Nicolas Danchin, Abdallah al-Salameh, Geneviève Derumeaux, Jean Doucet, Bruno Falissard, Francoise Forette, Olivier Hanon, Florence Pasquier, Michel Pinget, Rissane Ourabah, Celine Piedvache
Concern about the renal safety of commonly used cardiovascular drugs with demonstrated clinical benefit appears to be an obstacle to their use in the elderly. The objective was to describe the relationship between cardiovascular drugs and chronic kidney disease (CKD) in elderly individuals in the real-life setting. This is an ancillary study of the prospective non-interventional S.AGE (aged individuals) cohort. General physicians were free to prescribe any drug their patients needed. The participants were non-institutionalized patients aged 65 years and older treated by their primary physician for either chronic pain or atrial fibrillation or type 2 diabetes mellitus...
August 2015: Basic & Clinical Pharmacology & Toxicology
Feras Karadsheh, Matthew R Weir
Hypertension is often difficult to control in patients with chronic kidney disease. Clinicians often view thiazide and thiazide-like diuretics as being ineffective in reducing blood pressure in patients with chronic kidney disease, and prefer to use loop diuretics, especially if the estimated glomerular filtration rate (eGFR) is below 50 ml/min/1.73m(2). Recent clinical trial data indicate that thiazide and thiazide-like diuretics possess important and clinically significant antihypertension properties, that are likely independent of volume reduction, even in patients with eGFR in the 15-45 ml/min range...
2014: Current Hypertension Reviews
Ramapriya Sinnakirouchenan, Theodore A Kotchen
In patients with chronic kidney disease, an impaired capacity of the kidney to excrete sodium is a major contributor to hypertension. We discuss the role of sodium restriction and diuretic therapy for resistant hypertension in chronic kidney disease. Independent of increasing blood pressure, a sustained high sodium intake also may affect the progression of renal disease adversely. Consequently, dietary sodium restriction and appropriate diuretic therapy are the foundation for the treatment of resistant hypertension...
2014: Seminars in Nephrology
Maria Chiara Scali, Anca Simioniuc, Frank Lloyd Dini, Mario Marzilli
There is increasing interest in guiding Heart Failure (HF) therapy with Brain Natriuretic Peptide (BNP) or N-terminal prohormone of Brain Natriuretic Peptide (NT-proBNP), with the goal of lowering concentrations of these markers (and maintaining their suppression) as part of the therapeutic approach in HF. However, recent European Society of Cardiology (ESC) and American Heart Association/ American College of Cardiology (AHA/ACC) guidelines did not recommend biomarker-guided therapy in the management of HF patients...
2014: Cardiovascular Ultrasound
Domenic A Sica
Aldosterone-receptor antagonists dose-dependently reduce both the epithelial and nonepithelial actions of aldosterone. These compounds are used commonly in the treatment of hypertension, with or without aldosteronism, and in the volume-overload periods of various forms of heart failure, cirrhosis, and renal failure. In this regard, the relevant site of action for these compounds is compartmentalized to the distal nephron. The cardiac benefits of aldosterone-receptor blockade now are sufficiently well established to warrant routine use of these compounds for their survival benefits in moderate to advanced stages of heart failure...
May 2014: Seminars in Nephrology
Juan Tamargo, Anna Solini, Luis M Ruilope
The first aldosterone blocker, spironolactone, initially was used as a diuretic but was accompanied by a significant amount of side effects that necessitated the withdrawal of the drug in a relevant number of patients. The discovery of the many receptor-mediated actions of aldosterone in several different organs greatly contributed to expand the indications of aldosterone blockers. Eplerenone was the second component of this class of drugs and differed from spironolactone because of its significantly better safety, albeit this was accompanied by a lower potency when used at equinumeric doses...
May 2014: Seminars in Nephrology
Chao Liu, Kunshen Liu
Diuretic resistance in heart failure is defined as a state in which diuretic response is diminished or lost before the therapeutic goal of relief from congestion has been reached. Diuretic resistance is very common and is associated with poor outcomes. Over the past decade, several new drugs and devices targeting decongestion and improvement in renal function in patients with heart failure have failed to show benefit in randomized clinical trials. Glucocorticoids had been used to manage diuretic resistance before the advent of loop diuretics...
September 2014: Journal of Cardiac Failure
Mohammad Tahir, Simon Hassan, Simon de Lusignan, Lazza Shaheen, Tom Chan, Olga Dmitrieva
BACKGROUND: In the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases. This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731). METHODS: The questionnaire was developed by family physicians, primary care nurses, academics and renal specialists...
2014: BMC Nephrology
Rajat Deo, Wei Yang, Abigail M Khan, Nisha Bansal, Xiaoming Zhang, Mary B Leonard, Martin G Keane, Elsayed Z Soliman, Susan Steigerwalt, Raymond R Townsend, Michael G Shlipak, Harold I Feldman
Prior studies have demonstrated that elevated aldosterone concentrations are an independent risk factor for death in patients with cardiovascular disease. Limited studies, however, have evaluated systematically the association between serum aldosterone and adverse events in the setting of chronic kidney disease. We investigated the association between serum aldosterone and death and end-stage renal disease in 3866 participants from the Chronic Renal Insufficiency Cohort. We also evaluated the association between aldosterone and incident congestive heart failure and atherosclerotic events in participants without baseline cardiovascular disease...
July 2014: Hypertension
Dhssraj Singh, Kevin Shrestha, Jeffrey M Testani, Frederik H Verbrugge, Matthias Dupont, Wilfried Mullens, W H Wilson Tang
BACKGROUND: Treatment of acute decompensated heart failure (ADHF) with loop diuretics, such as furosemide, is frequently complicated by insufficient urine sodium excretion. We hypothesize that insufficient natriuretic response to diuretic therapy, characterized by lower urine sodium (UNa) and urine furosemide, is associated with subsequent inadequate decongestion, worsening renal function, and adverse long term events. METHODS AND RESULTS: We enrolled 52 consecutive patients with ADHF and measured serum and urine sodium (UNa), urine creatinine (UCr), and urine furosemide (UFurosemide) levels on a spot sample taken after treatment with continuous intravenous furosemide, and followed clinical and renal variables as well as adverse long-term clinical outcomes (death, rehospitalizations, and cardiac transplantation)...
June 2014: Journal of Cardiac Failure
Saskia Bruderer, Michael Bodmer, Susan S Jick, Christoph R Meier
OBJECTIVE: Use of diuretics has been associated with an increased risk of gout. Data on different types of diuretics are scarce. We undertook this study to investigate the association between use of loop diuretics, thiazide or thiazide-like diuretics, and potassium-sparing agents and the risk of developing incident gout. METHODS: We conducted a retrospective population-based case-control analysis using the General Practice Research Database established in the UK...
January 2014: Arthritis & Rheumatology
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