Loop diuretics are most appropriate for hypertension treatment in chronic kidney disease

The issues of diuretic therapy in patients with chronic kidney disease, pharmacokinetics of diuretics, the problem of diuretic resistance, the tactics of using thiazides and loop diuretics in patients with various stages of chronic kidney disease, according to the recommendations of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative are discussed in the article. Particular attention is paid to the prescription of this group of drugs to patients with end stage renal disease, as well as those undergoing renal replacement therapy (hemodialysis).Diuretics play an important role in the management of patients with chronic kidney disease with the development of hypertension and an increased extracellular fluid volume. In case of impaired renal function leading place is given to loop diuretics. Their combination with thiazide diuretics can increase the diuretic effect. The results of clinical trials assessing the effectiveness of the use of diuretics during decline of residual renal function are provided. It is reported about the effect of potassium-sparing diuretics on the incidence of cardiovascular complications, the development of hyperkalemia in patients undergoing dialysis treatment. The importance of continuation of intensive study about the possibility of antagonists of mineralocorticoid receptors usage, in particular the spironolactone, eplerenone, and finerenone in order to reduce cardiovascular complications and mortality, is indicated.

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A double-blind randomized crossover trial of two loop diuretics in chronic kidney disease

Kidney International ◽

10.1046/j.1523-1755.2003.00124.x ◽

2003 ◽

Vol 64 (2) ◽

pp. 632-640 ◽

Cited By ~ 30

Author(s):

Nina Vasavada ◽

Chandan Saha ◽

Rajiv Agarwal

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Crossover Trial ◽

Loop Diuretics ◽

Double Blind ◽

Randomized Crossover Trial

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Comparing loop diuretics in chronic kidney disease

Kidney International ◽

10.1111/j.1523-1755.2004.414_2.x ◽

2004 ◽

Vol 65 (1) ◽

pp. 337 ◽

Cited By ~ 1

Author(s):

Rajiv Agarwal

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Loop Diuretics

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Associated Factors of Chronic Kidney Disease among Hyponatraemic Elderly Patients Attending a Primary Care Clinic

Elderly Health Journal ◽

10.18502/ehj.v4i2.264 ◽

2018 ◽

Author(s):

Chai Li Tay

Keyword(s):

Primary Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Associated Factors ◽

Demographic Data ◽

Primary Care Clinic ◽

Loop Diuretics ◽

Care Clinic ◽

End Stage

Introduction: Chronic kidney disease (CKD) emerges to be an important geriatric health issue. It may progress to end stage renal failure and affect the quality of life. However, little is known about the associated factors of CKD. So this study aimed to determine the associated factors of CKD among hyponatraemic elderly. Methods: This is a retrospective study of hyponatraemic patients aged ≥ 60 years attending outpatient clinic in 2014. Blood test results of glucose, potassium, creatinine, medical history, blood pressure, medication and demographic data were captured from patient records. Each patient’s estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI Creatinine Equation. CKD is defined as eGFR of < 60 ml/min/1.73m2. SPSS 21 was used to do the analysis. Results: Totally 257 patients with mean age of 72.9 ± 7.3 years were enrolled in this study. Of them 73 (28.4 %) elderly had CKD. The mean eGFR was 72.62 ± 24.14 ml/min/1.73m2, mean BP was (135.75 ± 18/10) mmHg. Of the participants, 134 (52.1 %) were men, 151 (58.8 %) were diabetics, 247 (96.1 %) had hypertension. The independent associated factors of CKD were increasing age (OR 1.08; 95 % CI 1.03-1.13; p = 0.002), hyperglycaemia (OR 1.10; 95 % CI 1.02-1.18; p = 0.017) and the use of loop diuretics (OR 5.15; 95 % CI 1.52-17.38; p = 0.008). Conclusion: Hyperglycaemia and loop diuretics usage are found to be significantly associated with CKD among elderly patients attending a primary care clinic. Hence every effort should be made to optimise glucose control and cautious in the usage of loop diuretics to retard the decline in renal function.

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