The Na+-excreting efficacy of indapamide in combination with furosemide in massive edema

Tanaka, Misa; Oida, Emi; Nomura, Keiko; Nogaki, Fumiaki; Fukatsu, Atsushi; Uemura, Kazuhide; Yashiro, Masatomo; Kimura, Takeshi; Muso, Eri; T, Ono

doi:10.1007/s10157-005-0339-x

Cited by 12 publications

(6 citation statements)

References 7 publications

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“…21,22 A combined regimen (furosemide + HCTZ) was more potent than HCTZ or furosemide alone for increasing the fractional excretions of sodium and chloride. This result is in keeping with previous studies showing an increased efficacy of the coadministration of loop diuretics and thiazides over loop diuretics alone in patients with moderate reduction of GFR 23,24 and with stage 4 or 5 CKD. 25 These studies evaluated the short-term natriuretic response to a coadministration of loop diuretics and thiazides.…”

Section: Discussionsupporting

confidence: 92%

A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease

Dussol

Moussi-Francès

Morange

et al. 2011

J of Clinical Hypertension

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Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double‐blind, cross‐over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long‐acting furosemide (60 mg) and hydrochlorothiazide (25 mg) for 3 months and then both diuretics for 3 months. Sodium and chloride fractional excretions were measured after 3 months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the two diuretics increased the fractional excretions of sodium and chloride from 3.4±1.8 to 4.9±2.8 and from 3.8±2.0 to 6.0±3.1, respectively (P<.05). Furosemide and hydrochlorothiazide decreased mean blood pressure by the same extent. The association of the two diuretics was more efficient on blood pressure. There were no differences between furosemide and hydrochlorothiazide with respect to natriuresis and blood pressure control in patients with hypertension and chronic kidney disease.

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Section: Discussionsupporting

confidence: 92%

A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease

Dussol

Moussi-Francès

Morange

et al. 2011

J of Clinical Hypertension

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“…The most commonly used TD were metolazone, bendroflumethiazide, quinethazone, and hydrochlorothiazide. In addition to metolazone (45), LD augmentation was demonstrated using chlorothiazide (13,42), hydrochlorothiazide (43,47), quinethazone (20,21), indapamide (48), bendroflumethiazide (21,25), and butizide (49). Metolazone has been suggested to be superior to other TD in patients with advanced kidney disease (24,50), but other TD augment the response to LD, even in patients with advanced renal failure (26,47,49,51).…”

Section: Mechanism Of Action Of Diuretic Classesmentioning

confidence: 95%

Combination of Loop Diuretics With Thiazide-Type Diuretics in Heart Failure

Jentzer

DeWald

Hernandez

2010

Journal of the American College of Cardiology

345

232

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Volume overload is an important clinical target in heart failure management, typically addressed using loop diuretics. An important and challenging subset of heart failure patients exhibit fluid overload despite significant doses of loop diuretics. One approach to overcome loop diuretic resistance is the addition of a thiazide-type diuretic to produce diuretic synergy via "sequential nephron blockade," first described more than 40 years ago. Although potentially able to induce diuresis in patients otherwise resistant to high doses of loop diuretics, this strategy has not been subjected to large-scale clinical trials to establish safety and clinical efficacy. We summarize the existing literature evaluating the combination of loop and thiazide diuretics in patients with heart failure in order to describe the possible benefits and hazards associated with this therapy. Combination diuretic therapy using any of several thiazide-type diuretics can more than double daily urine sodium excretion to induce weight loss and edema resolution, at the risk of inducing severe hypokalemia in addition to hyponatremia, hypotension, and worsening renal function. We provide considerations about prudent use of this therapy and review potential misconceptions about this long-used diuretic approach. Finally, we seek to highlight the need for pragmatic clinical trials for this commonly used therapy.

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“…Consequently, the timing and choice of thiazide-type diuretics is often empiric, clinician-dependent, and not sufficiently data driven. Most of the studies and/or case series that do exist are quite small, usually lack comparator groups, and investigated a variety of different, older, and less commonly used thiazide-type diuretics compared to the agents more frequently used today [10][11][12][13][14][15][16][17][18][19][20][21][22]. In fact, to the best of our knowledge, not even a single study has been published comparing the effectivenes and safety of two of the most commonly utilized thiazide diuretics in HF, metolazone or chlorothiazide, as add-on therapy to loop diuretics in ADHF.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Metolazone Versus Chlorothiazide in Acute Decompensated Heart Failure with Diuretic Resistance

Moranville

Choi

Hogg

et al. 2015

Cardiovascular Therapeutics

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SUMMARYAims: Sequential nephron blockade with thiazide-like diuretics is a strategy used to overcome diuretic resistance in acute decompensated heart failure (ADHF), but head-to-head studies are lacking and equipoise exists regarding the preferred thiazide-like diuretic in this setting. We thus compared the effectiveness of oral metolazone versus intravenous (IV) chlorothiazide as add-on therapy to loop diuretics in hospitalized patients with ADHF and renal dysfunction. Methods: This retrospective cohort study evaluated the efficacy and safety of oral metolazone versus IV chlorothiazide as add-on therapy to loop diuretics in patients hospitalized with ADHF and renal dysfunction. The primary endpoint was net urine output (UOP) at 72 h after initiation of thiazide-like diuretics. Safety endpoints included worsening renal function, hypotension, and electrolyte abnormalities. Results: Fifty-five patients were enrolled with 33 patients receiving metolazone and 22 patients receiving chlorothiazide. There was no difference in median net UOP at 72 h in those receiving metolazone (4828 mL, interquartile range [IQR] 2800-7209 mL) compared to chlorothiazide (3779 mL, IQR 1885-6535 mL) (P = 0.16). There was no difference in hypotension, worsening renal function, hyponatremia, or hypokalemia (P = NS for all comparisons). Hospital length of stay was shorter in the metolazone cohort (median 7 days) compared to chlorothiazide (median 15 days), suggesting the chlorothiazide cohort was likely sicker. Conclusion: Sequential nephron blockade with either metolazone or chlorothiazide appears to be efficacious and safe in ADHF, renal dysfunction, and diuretic resistance. Given the considerable cost difference favoring oral metolazone, larger randomized studies are warranted to confirm our findings and to exclude the possibility of confounding by indication.

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The Na+-excreting efficacy of indapamide in combination with furosemide in massive edema

Abstract: This combination therapy appears to be effective in patients with massive edema, as it increased diuresis, and achieved potent Na+ excretion.

Cited by 12 publications

References 7 publications

A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease

A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease

Combination of Loop Diuretics With Thiazide-Type Diuretics in Heart Failure

Comparison of Metolazone Versus Chlorothiazide in Acute Decompensated Heart Failure with Diuretic Resistance

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