Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis

Lemes, Helton P.; Araújo, Salustiano Pereira de; Nascimento, Daniella; Cunha, Danny A.; García, César Pascual; Queiroz, Vinicius Kaiser; Ferreira-Filho, Sebastião Rodrigues

doi:10.1007/s10157-011-0427-z

Cited by 30 publications

(17 citation statements)

References 23 publications

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“…Given the risk of ototoxicity, use of diuretics in anuric patients on dialysis is not recommended (4,5). These compounds may have a role in those with preserved residual renal function as a maneuver to limit interdialytic weight gain (19); whether such an approach is useful or detrimental has not been adequately examined.…”

Section: Pharmacologic Management Of Hypertension In Patients On Dialmentioning

confidence: 99%

Pharmacotherapy of Hypertension in Chronic Dialysis Patients

Georgianos

Agarwal

2016

CJASN

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Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. β-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third-line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area.

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Section: Pharmacologic Management Of Hypertension In Patients On Dialmentioning

confidence: 99%

Pharmacotherapy of Hypertension in Chronic Dialysis Patients

Georgianos

Agarwal

2016

CJASN

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“…Medication classes for blood pressure management in dialysis Fosinopril did not reduce cardiovascular events and death compared with placebo in patients on HD with left ventricular hypertrophy 44 RCT: Inconsistent results related to ARBs and cardiovascular outcomes[45][46][47][48] Meta-analysis: ACEis/ARBs may reduce left ventricular mass index49 RCT: May preserve residual kidney function, especially in PD patients50,51 b-blockers RCT: Fewer heart failure hospitalizations with the b-blocker atenolol compared to the ACEi lisinopril in HD patients with hypertension and left ventricular hypertrophy 52 RCT: Lower risk of death and cardiovascular death with carvedilol versus placebo in HD patients with dilated cardiomyopathy who were also receiving digoxin and ACEi or ARB 53 Calcium channel blockers RCT: Amlodipine reduced cardiovascular events compared with placebo in HD patients with hypertension54 DiureticsProspective: May help preserve residual diuresis and limit fluid overload55,56 Prospective: Minimal effect on central hemodynamic indices and should not be considered an antihypertensive medication in the setting of dialysis57 Observational: Continuation of loop diuretics after HD initiation is associated with lower IDWG and lower intradialytic hypotension and hospitalization rates 58 Mineralocorticoid receptor antagonists RCT: Some trials in patients on dialysis have shown benefit on cardiovascular outcomes with spironolactone vs. placebo, 59-61 whereas others have not62 Ongoing RCTs: spironolactone and cardiovascular outcomes in HD patients (ACHIEVE and ALCHEMIST)63 …”

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confidence: 99%

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Flythe¹,

Chang²,

Gallagher³

et al. 2020

Kidney International

175

163

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“…Some studies have shown that the use of loop diuretics help salt and volume control and may help maintain RRF in dialysis patients [20][21][22] . DOPPS data from 3 continents, from nearly a decade ago, showed a wide variation in the use of diuretics from country to country ranging from 9% in the United States to 21% in Europe within the first 90 days of starting HD [22] .…”

Section: Discussionmentioning

confidence: 99%

UK National Survey of Practice Patterns of Fluid Volume Management in Haemodialysis Patients: A Need for Evidence

Dasgupta

Farrington²,

Davies³

et al. 2016

Blood Purif

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Background: Fluid management in haemodialysis (HD) affects patient experience, morbidity and mortality. Standards for best practice are lacking. A national survey of the United Kingdom was undertaken to define prevalent practice. Methods: An online questionnaire was distributed to all UK renal centres. Results: Forty-five of 74 centres (173 dialysis units), serving 62% (n = 14,697) of UK HD population responded. Seventy-eight per cent had no agreed policy for managing fluid balance in patients on HD; 44% did not assess fluid status routinely. Clinical assessment was the norm; 27% used bio-impedance-based device. To achieve a target-weight, 53% reduced weight as far as tolerated. Twenty-two per cent measured residual renal function (RRF). Ninety-one per cent had no policy for fluid overload. Sixty-four per cent restricted salt and water. Ninety-three per cent used diuretics in patients with RRF. Thirty-eight per cent felt management was adequate; 77% felt there was a need for better evidence. Ninety-one per cent would participate in a study addressing this. Conclusion: There is an urgent need for establishing an evidence base on the optimal approaches to fluid management.

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Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis

Abstract: The results of this study have shown that chronic use of small doses of furosemide in chronic renal patients with residual diuresis could increase urinary volume and sodium excretion compared to patients who did not use this drug.

Cited by 30 publications

References 23 publications

Pharmacotherapy of Hypertension in Chronic Dialysis Patients

Pharmacotherapy of Hypertension in Chronic Dialysis Patients

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

UK National Survey of Practice Patterns of Fluid Volume Management in Haemodialysis Patients: A Need for Evidence

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