The Effects of Diuresis on the Pharmacokinetics of the Loop Diuretics Furosemide and Torsemide in Patients with Heart Failure

1998 ◽  
Vol 104 (6) ◽  
pp. 533-538 ◽  
Author(s):  
Stephen S Gottlieb ◽  
Meenakshi Khatta ◽  
Derek Wentworth ◽  
David Roffman ◽  
Michael L Fisher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Loop Diuretics ◽  
Patients With Heart Failure

scholarly journals Oral Metolazone Versus Intravenous Chlorothiazide as an Adjunct to Loop Diuretics for Diuresis in Acute Decompensated Heart Failure With Reduced Ejection Fraction

2018 ◽  
Vol 54 (6) ◽  
pp. 351-357 ◽  
Author(s):  
Brian C. Bohn ◽  
Rim M. Hadgu ◽  
Hannah E. Pope ◽  
Jerrica E. Shuster
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Oral Formulation ◽  
Loop Diuretics ◽  
Reduced Ejection Fraction ◽  
Significant Difference ◽  
Patients With Heart Failure ◽  
Total Urine

Background: Thiazide diuretics are often utilized to overcome loop diuretic resistance when treating acute decompensated heart failure (ADHF). In addition to a large cost advantage, several pharmacokinetic advantages exist when administering oral metolazone (MTZ) compared with intravenous (IV) chlorothiazide (CTZ), yet many providers are reluctant to utilize an oral formulation to treat ADHF. The purpose of this study was to compare the increase in 24-hour total urine output (UOP) after adding MTZ or CTZ to IV loop diuretics (LD) in patients with heart failure with reduced ejection fraction (HFrEF). Methods and Results: From September 2013 to August 2016, 1002 patients admitted for ADHF received either MTZ or CTZ in addition to LD. Patients were excluded for heart failure with preserved ejection fraction (HFpEF) (n = 469), <24-hour LD or UOP data prior to drug initiation (n = 129), or low dose MTZ/CTZ (n = 91). A total of 168 patients were included with 64% receiving CTZ. No significant difference was observed between the increase in 24-hour total UOP after MTZ or CTZ initiation (1458 [514, 2401] mL vs 1820 [890, 2750] mL, P = .251). Conclusions: Both MTZ and CTZ similarly increased UOP when utilized as an adjunct to IV LD. These results suggest that while thiazide agents can substantially increase UOP in ADHF patients with HFrEF, MTZ and CTZ have comparable effects.

scholarly journals Hyponatremia in Heart Failure: Pathogenesis and Management

2019 ◽  
Vol 15 (4) ◽  
pp. 252-261 ◽  
Author(s):  
Mario Rodriguez ◽  
Marcelo Hernandez ◽  
Wisit Cheungpasitporn ◽  
Kianoush B. Kashani ◽  
Iqra Riaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Treatment Options ◽  
Volume Overload ◽  
Renal Perfusion ◽  
Loop Diuretics ◽  
Fluid Restriction ◽  
First Case ◽  
Patients With Heart Failure ◽  
Promising Treatment ◽  
Short And Long Term

Hyponatremia is a very common electrolyte abnormality, associated with poor short- and long-term outcomes in patients with heart failure (HF). Two opposite processes can result in hyponatremia in this setting: Volume overload with dilutional hypervolemic hyponatremia from congestion, and hypovolemic hyponatremia from excessive use of natriuretics. These two conditions require different therapeutic approaches. While sodium in the form of normal saline can be lifesaving in the second case, the same treatment would exacerbate hyponatremia in the first case. Hypervolemic hyponatremia in HF patients is multifactorial and occurs mainly due to the persistent release of arginine vasopressin (AVP) in the setting of ineffective renal perfusion secondary to low cardiac output. Fluid restriction and loop diuretics remain mainstay treatments for hypervolemic/ dilutional hyponatremia in patients with HF. In recent years, a few strategies, such as AVP antagonists (Tolvaptan, Conivaptan, and Lixivaptan), and hypertonic saline in addition to loop diuretics, have been proposed as potentially promising treatment options for this condition. This review aimed to summarize the current literature on pathogenesis and management of hyponatremia in patients with HF.

scholarly journals Serum and Urine Albumin and Response to Loop Diuretics in Heart Failure

2019 ◽  
Vol 14 (5) ◽  
pp. 712-718 ◽  
Author(s):  
Antonios Charokopos ◽  
Matthew Griffin ◽  
Veena S. Rao ◽  
Lesley Inker ◽  
Krishna Sury ◽  
...  
Keyword(s):  
Heart Failure ◽  
Serum Albumin ◽  
Transitional Care ◽  
Care Center ◽  
Loop Diuretics ◽  
Human Heart Failure ◽  
Diuretic Resistance ◽  
Urine Albumin ◽  
Patients With Heart Failure ◽  
Diuretic Efficiency

Background and objectivesDiuretic resistance can limit successful decongestion of patients with heart failure. Because loop diuretics tightly bind albumin, low serum albumin and high urine albumin can theoretically limit diuretic delivery to the site of action. However, it is unknown if this represents a clinically relevant mechanism of diuretic resistance in human heart failure.Design, setting, participants, & measurementsIn total, 208 outpatients with heart failure at the Yale Transitional Care Center undergoing diuretic treatment were studied. Blood and urine chemistries were collected at baseline and 1.5 hours postdiuretic administration. Urine diuretic levels were normalized to urine creatinine and adjusted for diuretic dose administered, and diuretic efficiency was calculated as sodium output per doubling of the loop diuretic dose. Findings were validated in an inpatient heart failure cohort (n=60).ResultsSerum albumin levels in the outpatient cohort ranged from 2.4 to 4.9 g/dl, with a median of 3.7 g/dl (interquartile range, 3.5–4.1). Serum albumin had no association with urinary diuretic delivery (r=−0.05; P=0.52), but higher levels weakly correlated with better diuretic efficiency (r=0.17; P=0.02). However, serum albumin inversely correlated with systemic inflammation as assessed by plasma IL-6 (r=−0.35; P<0.001), and controlling for IL-6 eliminated the diuretic efficiency-serum albumin association (r=0.12; P=0.12). In the inpatient cohort, there was no association between serum albumin and urinary diuretic excretion (r=0.15; P=0.32) or diuretic efficiency (r=−0.16; P=0.25). In the outpatient cohort, 39% of patients had microalbuminuria, and 18% had macroalbuminuria. There was no correlation between albuminuria and diuretic efficiency after adjusting for kidney function (r=−0.02; P=0.89). Results were similar in the inpatient cohort.ConclusionsSerum albumin levels were not associated with urinary diuretic excretion, and urinary albumin levels were not associated with diuretic efficiency.

scholarly journals Associations of worsening renal function with loop diuretics in patients with heart failure with different ejection fraction categories

2020 ◽  
Author(s):  
Marvin Owusu-Ayeman ◽  
Xin He ◽  
Weihao Liang ◽  
Wengen Zhu ◽  
Yuzhong Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Ejection Fraction ◽  
Equivalent Dose ◽  
Loop Diuretics ◽  
Close Monitoring ◽  
Odds Ratios ◽  
Reduced Ejection Fraction ◽  
Worsening Renal Function ◽  
Patients With Heart Failure

Abstract Background Heart failure patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) have different sensitivity to plasma volume change after decongestion, but the possible differential effects of loop diuretics dosage on worsening renal function (WRF) in heart failure (HF) categories remain unclear. Methods In 972 patients with HFpEF and 427 patients with HFrEF, we assessed the risk of WRF with the average daily furosemide equivalent dose, using multivariable logistic regression. WRF was defined as an increase in serum creatinine levels of more than 26.5 mmol/L during hospitalization. Results In patients with HFpEF and HFrEF, between-group differences in average daily furosemide equivalent dose (18.9 mg/d vs. 26.8 mg/d) and the prevalence of WRF (25.3% vs. 14.3%) were significant (p < 0.001). In multivariable-adjusted analyses, a doubling of the average furosemide equivalent dose was associated with higher risk of WRF in all patients, patients with HFpEF and HFrEF, with odds ratios amounting to 1.42, 1.41 and 1.60 (p ≤ 0.022), respectively. There was no interaction between heart failure categories and average furosemide equivalent dose (p = 0.37). The adjusted odds ratios of risk of WRF associated with intravenous furosemide were 1.26 (95% confidence interval [CI], 1.08–1.46; p = 0.002) in HFpEF but not significant in HFrEF(p = 0.099). Conclusions The risk of WRF was associated with higher furosemide dosage in both HF subtypes. Our observations highlight that close monitoring is required to prevent further renal impairment in all HF patients while using loop diuretics.

scholarly journals Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction

2015 ◽  
Vol 18 (3) ◽  
pp. 328-336 ◽  
Author(s):  
Kevin Damman ◽  
John Kjekshus ◽  
John Wikstrand ◽  
John G.F. Cleland ◽  
Michel Komajda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Clinical Outcome ◽  
Ejection Fraction ◽  
Loop Diuretics ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

I diuretici dell’ansa nella terapia di mantenimento del paziente con scompenso cardiaco

2004 ◽  
Vol 5 (3) ◽  
pp. 133-140
Author(s):  
Franco Cecchi
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Hospital Readmissions ◽  
Loop Diuretics ◽  
Aldosterone Antagonists ◽  
Cardiovascular Morbidity And Mortality ◽  
Patients With Heart Failure

Diuretics are still a cornerstone of acute heart failure. Their role in chronic heart failure has recently been reconsidered, as Ace-inhibitors and Beta-blockers have been shown to be highly effective in reducing cardiovascular morbidity and mortality in patients with heart failure. Loop diuretics and aldosterone antagonists, however, are still used in chronic heart failure, at the lowest dose needed in order to mantain haemodynamic balance. The use of effective loop diuretics with longer half-lives and constant bioavailability may be beneficial, resulting in fewer hospital readmissions, both for congestive heart failure and all cardiovascular events, in improved quality of life and in health costs reduction.

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