Potent Potentiating Diuretic Effects of Prednisone in Congestive Heart Failure

Abstract

This pilot study showed that prednisone had potent potentiating diuretic effects in patients with heart failure and might improve renal function in the same time. Further prospective randomized clinical studies are warranted to determine the preferable dose and its efficacy in decompensated congestive heart failure.

Glucocorticoids Improve Renal Responsiveness to Atrial Natriuretic Peptide by Up-Regulating Natriuretic Peptide Receptor-A Expression in the Renal Inner Medullary Collecting Duct in Decompensated Heart Failure

“…Contrary to the notion that glucocorticoids cause renal water and sodium retention, evidence showed glucocorticoid administration could produce potent diuresis and natriuresis in rats (Thunhorst et al, 2007;Liu et al, 2010). It has also been found, in clinical observations, that chronic glucocorticoid administration could produce potent diuresis and restore body fluid homeostasis in patients with heart failure and severe fluid overload (Liu et al, 2006(Liu et al, , 2007Zhang et al, 2008;Massari et al, 2011). Previous evidence showed that glucocorticoids could up-regulate ANP mRNA expression in the atrial myocytes and increase ANP levels in the circulation (Gardner et al, 1988;Dananberg and Grekin, 1992).…”

“…In heart patients with severe fluid retention, glucocorticoids could induced potent diuretic effect and restore fluid hemostasis (Liu et al, 2006(Liu et al, , 2007Zhang et al, 2008;Massari et al, 2011). Recently, we demonstrated that glucocorticoids even produced potent diuresis in rats with overnight water deprivation (Liu et al, 2010).…”

Prednisone Adding to Usual Care Treatment for Refractory Decompensated Congestive Heart Failure

“…Also, glucocorticoids may promote natriuretic peptide excretion and upregulate their receptors in kidney, thus demonstrating a natriuretic peptide sensitizer-like effect. 6,8) However, a drawback is that diuresis induced by prednisone is time-dependent, ie, there is, usually a lag time of 3 days for prednisone, as we described previously, before its effects are exerted in patients with heart failure. Of note, adding prednisone to conventional care resulted in reductions in serum creatinine and uric acid, and slight increases in BUN.…”

“…In previous studies, we found that prednisone had potent diuretic effects in patients with stable congestive heart failure, and could restore renal function and elicit potent diuretic effects even in heart failure patients with refractory diuretic resistance. [6][7][8] Thus, prednisone may be a new drug candidate for patients with DCHF.…”

Cardiac Outcome Prevention Effectiveness of Glucocorticoids in Acute Decompensated Heart Failure

“…7,8 Importantly, newly conducted clinical studies showed that glucocorticoids could produce a potent diuresis and improvement in renal function in patients with decompensated heart failure. [9][10][11][12][13] The objectives of this multicenter, nonblinded randomized trial are to assess the safety, tolerability, and efficacy of glucocorticoid therapy in patients with ADHF. The study was stopped prematurely because of slow site initiation and enrolment.…”