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diuretic titration

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https://www.readbyqxmd.com/read/29129996/addressing-hypertension-in-the-patient-with-type-2-diabetes-mellitus-pathogenesis-goals-and-therapeutic-approach
#1
Ali A Rizvi
Hypertension is considered a powerful cardiovascular risk factor and is present in up to two-thirds of patients who suffer from diabetes. In the background of an established epidemiological association between lower blood pressure (BP) and improvement in long-term clinical outcomes, several large landmark trials and analyses have attempted to examine the possible benefit of tighter BP control in patients with Type 2 diabetes mellitus. Although aggressive BP targets in patients with diabetes have been advocated for a long time, currently accepted evidence from these studies has led to a general recommendation of systolic BP <140 mmHg and diastolic BP <90 mmHg...
October 2017: European Medical Journal. Diabetes
https://www.readbyqxmd.com/read/29105751/real-life-use-of-neurohormonal-antagonists-and-loop-diuretics-in-chronic-heart-failure-analysis-of-serial-biomarker-measurements-and-clinical-outcome
#2
Milos Brankovic, K Martijn Akkerhuis, Nick van Boven, Olivier Manintveld, Tjeerd Germans, Jasper Brugts, Kadir Caliskan, Victor Umans, Alina Constantinescu, Isabella Kardys
We determined the temporal effects of neurohormonal antagonists and loop diuretics on serially assessed (3-monthly) cardio-renal biomarkers, functional status, and clinical outcomes in 250 patients with chronic heart failure (CHF) with reduced ejection fraction. In blood, we measured NT-proBNP, troponin T, C-reactive protein, creatinine, cystatin C; in urine, N-acetyl-beta-d-glucosaminidase and kidney-injury-molecule-1. ACE-inhibitors/ARB were inversely associated with cardiac impairment, inflammation and renal tubular damage, but not with glomerular dysfunction...
November 6, 2017: Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29056238/value-of-routine-investigations-to-predict-loop-diuretic-down-titration-success-in-stable-heart-failure
#3
Pieter Martens, Frederik H Verbrugge, Levinia Boonen, Petra Nijst, Matthias Dupont, Wilfried Mullens
AIMS: Guidelines advocate down-titration of loop diuretics in chronic heart failure (CHF) when patients have no signs of volume overload. Limited data are available on the expected success rate of this practice or how routine diagnostic tests might help steering this process. METHODS AND RESULTS: Fifty ambulatory CHF-patients on stable neurohumoral blocker/diuretic therapy for at least 3months without any clinical sign of volume overload were prospectively included to undergo loop diuretic down-titration...
October 6, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28984663/practical-management-of-concomitant-acute-heart-failure-and-worsening-renal-function-in-the-emergency-department
#4
João Pedro Ferreira, Tahar Chouihed, Pierre Naseyrollas, Bruno Levy, Marie F Seronde, Pascal Bilbault, François Braun, Gérald Roul, David Kénizou, Noura Zannad, Nicolas Girerd, Patrick Rossignol
Worsening renal function (i.e. any increase in creatinine or decrease in the estimated glomerular filtration rate) is common in patients admitted for acute heart failure in the emergency department. Although worsening renal function (WRF) has been associated with the occurrence of dismal outcomes, this only appears to be the case when associated with clinical deterioration. However, if the clinical status of the patient is improving, a certain increase in serum creatinine may be acceptable. This WRF, which is not associated with clinical deterioration or adverse outcomes (e...
October 3, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28971753/loop-diuretic-down-titration-in-stable-chronic-heart-failure-is-often-achievable-especially-when-urinary-chloride-concentration-is-low
#5
Frederik H Verbrugge, Pieter Martens, Levinia Boonen, Petra Nijst, David Verhaert, Patrick Noyens, Philip De Vusser, Matthias Dupont, W H Wilson Tang, Wilfried Mullens
BACKGROUND: This study investigates spot urinary chloride concentration in euvolemic chronic heart failure (CHF) patients. METHODS: This prospective cohort study included 50 ambulatory CHF patients on maintenance loop diuretics without recent hospital admission, clinical signs of volume overload, or adjustment in neurohumoral blocker or diuretic therapy. Spot urinary samples were collected immediately after loop diuretic intake. Subsequently, loop diuretic dose was reduced with 50% or stopped if ≤40 mg furosemide equivalents...
October 3, 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28953839/antidepressants-and-hyponatremia-in-a-patient-with-colectomy-a-case-report
#6
Madhavan Seshadri, Madhusudan Deepak Thalitaya, Tuno Simon, Catherine Odelola, Humphrey Enow
Antidepressants are routinely used by General Practitioners (GP) as well as Psychiatrists to treat Depression. They are tolerated well. However, in certain patient populations, they are associated with SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone Secretion) and Hyponatremia. Various research studies have shown that all antidepressants are associated with Hyponatremia. Hyponatremia as a side effect of antidepressant therapy is more commonly seen in old age, chronic Kidney disease and Hypothyroidism...
September 2017: Psychiatria Danubina
https://www.readbyqxmd.com/read/28826670/heart-failure-transitions-of-care-a-pharmacist-led-post-discharge-pilot-experience
#7
Sherry K Milfred-LaForest, Julie A Gee, Adam M Pugacz, Ileana L Piña, Danielle M Hoover, Robert C Wenzell, Aubrey Felton, Eric Guttenberg, Jose Ortiz
OBJECTIVE: To perform a pilot evaluation of a pharmacist-led, multidisciplinary transitional care clinic for heart failure (HF) patients. BACKGROUND: Transitions of care in HF should include: medication reconciliation, multidisciplinary care, early post-discharge follow-up, and prompt intervention on HF signs and symptoms. We hypothesized that combining these elements with optimization of medications would impact outcomes. METHODS: In the SERIOUS HF Medication Reconciliation Transitional Care Clinic (HF MRTCC), patients were seen by a clinical pharmacist trained in HF...
September 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28803333/low-dose-tolvaptan-pk-pd-comparison-of-patients-with-hyponatremia-due-to-syndrome-of-inappropriate-antidiuretic-hormone-secretion-to-healthy-adults
#8
Susan E Shoaf, Patricia Bricmont, Ann Dandurand
PURPOSE: Tolvaptan (TLV) is indicated to treat hyponatremia due to syndrome of inappropriate diuretic hormone (SIADH) in Europe. Treatment is to be initiated at 15 mg QD but post-approval reporting indicates increasing use of 7.5 mg as the starting dose. Physicians believe 7.5 mg is effective and has a lower incidence of overly rapid correction of serum sodium. METHODS: Single TLV doses of 3.75, 7.5, and 15 mg were administered to 14 healthy adults in a crossover design and to 29 subjects ≥18 years with SIADH and serum sodium between 120 and 133 mmol/L in a parallel-group design...
November 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28666669/medical-treatment-of-nocturia-in-men-with-lower-urinary-tract-symptoms-systematic-review-by-the-european-association-of-urology-guidelines-panel-for-male-lower-urinary-tract-symptoms
#9
REVIEW
Vasileios I Sakalis, Markos Karavitakis, Dina Bedretdinova, Thorsten Bach, J L H Ruud Bosch, Mauro Gacci, Christian Gratzke, Thomas R Herrmann, Stephan Madersbacher, Charalampos Mamoulakis, Kari A O Tikkinen, Stavros Gravas, Marcus J Drake
CONTEXT: The treatment of nocturia is a key challenge due to the multi-factorial pathophysiology of the symptom and the disparate outcome measures used in research. OBJECTIVE: To assess and compare available therapy options for nocturia, in terms of symptom severity and quality of life. EVIDENCE ACQUISITION: Medical databases (Embase, Medline, Cochrane Systematic Reviews, Cochrane Central) were searched with no date restriction. Comparative studies were included which studied adult men with nocturia as the primary presentation and lower urinary tract symptoms including nocturia or nocturnal polyuria...
November 2017: European Urology
https://www.readbyqxmd.com/read/28645705/acid-load-and-phosphorus-homeostasis-in-ckd
#10
Pascale Khairallah, Tamara Isakova, John Asplin, Lee Hamm, Mirela Dobre, Mahboob Rahman, Kumar Sharma, Mary Leonard, Edgar Miller, Bernard Jaar, Carolyn Brecklin, Wei Yang, Xue Wang, Harold Feldman, Myles Wolf, Julia J Scialla
BACKGROUND: The kidneys maintain acid-base homeostasis through excretion of acid as either ammonium or as titratable acids that primarily use phosphate as a buffer. In chronic kidney disease (CKD), ammoniagenesis is impaired, promoting metabolic acidosis. Metabolic acidosis stimulates phosphaturic hormones, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) in vitro, possibly to increase urine titratable acid buffers, but this has not been confirmed in humans. We hypothesized that higher acid load and acidosis would associate with altered phosphorus homeostasis, including higher urinary phosphorus excretion and serum PTH and FGF-23...
October 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28612323/risk-assessment-and-outcomes-of-vasoplegia-after-cardiac-surgery
#11
Athanasios Tsiouris, Lynn Wilson, Ala S Haddadin, James J Yun, Abeel A Mangi
OBJECTIVE: The aim of this study was to analyze risk factors and outcomes of vasoplegia after cardiac surgery based on our experience with almost 2000 cardiac operations performed at our institution. METHODS: We retrospectively analyzed patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) between 2011 and 2013. Data were available for a total of 1992 patients. We defined vasoplegia as hypotension with persistently low systemic vascular resistance (<800 dyn/s/cm) and preserved Cardiac Index (>2...
October 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28586537/patient-reported-outcomes-in-the-soluble-guanylate-cyclase-stimulator-in-heart-failure-patients-with-preserved-ejection-fraction-socrates-preserved-study
#12
Gerasimos Filippatos, Aldo P Maggioni, Carolyn S P Lam, Elisabeth Pieske-Kraigher, Javed Butler, John Spertus, Piotr Ponikowski, Sanjiv J Shah, Scott D Solomon, Andrea-Viviana Scalise, Katharina Mueller, Lothar Roessig, Luke Bamber, Mihai Gheorghiade, Burkert Pieske
AIMS: Exploratory assessment of the potential benefits of the novel soluble guanylate cyclase stimulator vericiguat on health status in patients with heart failure (HF) with preserved ejection fraction. METHODS AND RESULTS: The SOCRATES-PRESERVED trial randomized patients with chronic HF and ejection fraction ≥ 45% within 4 weeks of decompensation to 12 weeks of treatment with titrated doses of vericiguat (1.25, 2.5, 5, and 10 mg once daily) or placebo. Health status was assessed with the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) and the generic health-related quality of life measure EQ-5D...
June 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28577069/prevention-of-acute-kidney-injury-and-protection-of-renal-function-in-the-intensive-care-unit-update-2017-expert-opinion-of-the-working-group-on-prevention-aki-section-european-society-of-intensive-care-medicine
#13
M Joannidis, W Druml, L G Forni, A B J Groeneveld, P M Honore, E Hoste, M Ostermann, H M Oudemans-van Straaten, M Schetz
BACKGROUND: Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. OBJECTIVES: To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles. METHOD: A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI...
June 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28532770/changes-in-loop-diuretic-dose-and-outcome-after-cardiac-resynchronization-therapy-in-patients-with-heart-failure-and-reduced-left-ventricular-ejection-fractions
#14
Pieter Martens, Frederik H Verbrugge, Petra Nijst, Matthias Dupont, Wilfried Mullens
Cardiac resynchronization therapy (CRT) improves cardiac hemodynamics. Therefore, the maintenance dose of loop diuretic therapy might be reduced. Consecutive patients who underwent CRT (n = 648) were retrospectively evaluated. Loop diuretic dose was recorded at baseline before implantation and 6 months later with patients classified into 4 groups: (1) no loop diuretic, (2) down-titration, (3) unchanged dose, and (4) up-titration. Afterward total loop diuretic exposure was calculated. Renal function trajectories were evaluated as the difference between implantation and censoring serum creatinine (Cr) value...
July 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28398366/-diuretic-treatment-in-patients-with-chronic-heart-failure-evidences-experiences-and-current-perspectives
#15
REVIEW
Pierpaolo Pellicori, Valentina Carubelli
Congestion is a fundamental clinical sign in patients with chronic heart failure (CHF). Diuretics are the mainstay treatment for congestion but, so far, no randomized trial has ever shown any beneficial effect of diuretics on mortality in patients with CHF. It is also unclear how and when diuretics should be up, or down titrated, or when their use can be safely stopped. In this review, we discuss current evidence regarding the clinical use of diuretics. We also highlight the need for more clinical trials to explore the short- and long-term safety, efficacy and clinical benefits of different classes of diuretics, used alone or in combination, in patients with CHF...
February 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/28369340/vericiguat-in-patients-with-worsening-chronic-heart-failure-and-preserved-ejection-fraction-results-of-the-soluble-guanylate-cyclase-stimulator-in-heart-failure-patients-with-preserved-ef-socrates-preserved-study
#16
RANDOMIZED CONTROLLED TRIAL
Burkert Pieske, Aldo P Maggioni, Carolyn S P Lam, Elisabeth Pieske-Kraigher, Gerasimos Filippatos, Javed Butler, Piotr Ponikowski, Sanjiv J Shah, Scott D Solomon, Andrea-Viviana Scalise, Katharina Mueller, Lothar Roessig, Mihai Gheorghiade
Aims: To determine tolerability and the optimal dose regimen of the soluble guanylate cyclase stimulator vericiguat in patients with chronic heart failure and preserved ejection fraction (HFpEF). Methods and results: SOCRATES-PRESERVED was a prospective, randomized, placebo-controlled double-blind, Phase 2b dose-finding study in patients with HFpEF (ejection fraction ≥ 45%). Patients received vericiguat once daily at 1.25 or 2.5 mg fixed doses, or 5 or 10 mg titrated from a 2...
April 14, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28356904/clinical-utility-of-patiromer-sodium-zirconium-cyclosilicate-and-sodium-polystyrene-sulfonate-for-the-treatment-of-hyperkalemia-an-evidence-based-review
#17
REVIEW
Mario V Beccari, Calvin J Meaney
INTRODUCTION: Hyperkalemia is a serious medical condition that often manifests in patients with chronic kidney disease and heart failure. Renin-angiotensin-aldosterone system inhibitors are known to improve outcomes in these disease states but can also cause drug-induced hyperkalemia. New therapeutic options exist for managing hyperkalemia in these patients which warrant evidence-based evaluation. AIM: The objective of this article was to review the efficacy and safety evidence for patiromer, sodium zirconium cyclosilicate (ZS9), and sodium polystyrene sulfonate (SPS) for the treatment of hyperkalemia...
2017: Core Evidence
https://www.readbyqxmd.com/read/28341415/diuretic-strategies-in-acute-heart-failure-and-renal-dysfunction-conventional-vs-carbohydrate-antigen-125-guided-strategy-clinical-trial-design
#18
Sergio García-Blas, Clara Bonanad, Pau Llàcer, Silvia Ventura, José María Núñez, Ruth Sánchez, Carlos Chamorro, Lorenzo Fácila, Rafael de la Espriella, Juana María Vaquer, Alberto Cordero, Mercè Roqué, Víctor Ortiz, Paolo Racugno, Vicent Bodí, Ernesto Valero, Enrique Santas, María Del Carmen Moreno, Gema Miñana, Arturo Carratalá, Lourdes Bondanza, Ana Payá, Ingrid Cardells, Raquel Heredia, Mauricio Pellicer, Guillermo Valls, Patricia Palau, María José Bosch, Rafael Raso, Andrés Sánchez, Vicente Bertomeu-González, Vicente Bertomeu-Martínez, Vicente Montagud-Balaguer, Cristina Albiach-Montañana, Jezabel Pendás-Meneau, Goitzane Marcaida, Sonia Cervantes-García, Rodolfo San Antonio, Elisabet de Mingo, Francisco J Chorro, Juan Sanchis, Julio Núñez
INTRODUCTION AND OBJECTIVES: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1...
March 21, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28325523/total-management-of-chronic-obstructive-pulmonary-disease-copd-as-an-independent-risk-factor-for-cardiovascular-disease
#19
REVIEW
Katsuya Onishi
Patients with cardiovascular disease (CVD) often have multiple comorbid conditions that may interact with each other, confound the choice of treatments, and reduce mortality. Chronic obstructive pulmonary disease (COPD) is one of the most important comorbidities of CVD, which causes serious consequences in patients with ischemic heart disease, stroke, arrhythmia, and heart failure. COPD shares common risk factors such as tobacco smoking and aging with CVD, is associated with less physical activity, and produces systemic inflammation and oxidative stress...
March 18, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28237959/comparison-of-efficacy-and-safety-between-benidipine-and-hydrochlorothiazide-in-fosinopril-treated-hypertensive-patients-with-chronic-kidney-disease-protocol-for-a-randomised-controlled-trial
#20
Cheng Xue, Chenchen Zhou, Bo Yang, Jiayi Lv, Bing Dai, Shengqiang Yu, Yi Wang, Guanren Zhao, Changlin Mei
INTRODUCTION: Co-administration of a diuretic or calcium channel blocker with an ACE inhibitor are both preferred combinations in patients with hypertensive chronic kidney disease (CKD). According to the available evidence, it is still unknown which combination plays a more active role in renal protection. We hypothesised that a combination of fosinopril and benidipine may delay the progression of CKD more effectively than a combination of fosinopril and hydrochlorothiazide (HCTZ). METHODS AND ANALYSIS: This study will be a multicentred, prospective, double-blind, randomised parallel controlled trial for hypertensive CKD patients in China...
February 24, 2017: BMJ Open
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