Acute Effects of High-Dose Furosemide on Residual Renal Function in CAPD Patients

Abstract

♦ Background High doses of furosemide can increase urine volume in chronic peritoneal dialysis (CAPD) patients. However, no information is available about effects on urinary solute excretion in relation to residual glomerular filtration rate (GFR), urinary furosemide excretion, and peritoneal solute kinetics. ♦ Methods Diuretic response and the effect on peritoneal fluid and solute transport parameters were investigated in 7 stable CAPD patients with residual renal function (median urine volume 350 mL/24 hours, range 140–1900 mL/24 hours). Comparisons were made during two clearance periods of 24 hours: one without (P1) and one during 2 g furosemide (P2). ♦ Results The median increase in urine volume was 400 mL (range 270 – 910 mL, p < 0.02) and the increase in sodium excretion was 54 mmol (range 25 –118 mmol, p < 0.02). No change in GFR was found between P1 (2.4 mL/minute, range 0.6 – 5.7 mL/min) and P2 (2.0 mL/min, range 1.0 – 4.8 mL/min). An increase in fractional clearance was found for volume, sodium, potassium, and osmolality ( p < 0.02). No change was found in the fractional clearance of urea and electrolyte-free water. Furosemide excretion in urine was 8.7 mg/24 hours (range 2.1 – 38 mg/24 hours) and in dialysate 4.9 mg/24 hours (range 1.9 – 7.8 mg/24 hours). Plasma furosemide concentration was 29.5 mg/L (range 6.2 – 43.9 mg/L). A positive correlation was found between residual GFR and total urine furosemide excretion ( r=0.93, p < 0.005). Efficiency, expressed as the increase in fractional sodium clearance (percent) per milligram of furosemide excreted per 24 hours, was 1.2%/mg (range 0.3%–11.3%/mg). ♦ Conclusion High-dose furosemide is effective in CAPD patients in increasing urine volume and electrolyte excretion without affecting urea and creatinine clearance. In CAPD patients, the individual response to an identical high dose of furosemide is dependent on the magnitude of residual GFR.

Management of Chronic Heart Failure in Dialysis Patients: A Challenging but Rewarding Path

“…The lower risk of hyperkalemia in PD patients compared to HD patients is due to better continuity of treatment in PD patients [ 38 ]. Patients treated with PD retained RRF longer and use higher diuretic doses than HD patients [ 39 ]. Consequently, PD patients are at higher risk for hypokalemia [ 40 ].…”

A review of residual kidney function in peritoneal dialysis patients

“…[ 36 ] The effect of diuretics on RKF loss remains controversial and was not reproduced in other studies. [ 37 38 ]…”

“…Another study that examined the use of high-dose furosemide (2 g) over 24 h in CAPD patients found it to be effective in increasing the urine volume by a median of 400 ml (range 270–910 ml, P < 0.02), but had no effect on GFR. [ 38 ] In two studies from Taiwan, the use of diuretics was associated with faster RKF decline. [ 36 63 ] It is unclear if an increase in urine volume from diuretics translates into better outcome in PD patients.…”

Management of intradialytic hypertension: current evidence and future perspectives

“…In the overall hemodialysis population, the major antihypertensive drug classes are considered useful for the pharmacological treatment of hypertension in dialysis [3,23,[41][42][43]. With regards to the role of loop diuretics, small studies suggest that they may help patients on hemodialysis with preserved residual diuresis to enhance urine output and limit fluid overload [44][45][46][47] but in anuric hemodialysis patients, even high doses of intravenous loop diuretics exert only minimal alterations in central hemodynamic indices [48]. Furthermore, the effect of these agents on BP control has not been examined in ambulatory conditions in hemodialysis patients; thus their overall usefulness for BP control remains to be examined.…”