scholarly journals Pharmacogenetics as a Way for Personalizing Diuretic Therapy: Focus on Torasemide

2021 ◽  
Vol 17 (1) ◽  
pp. 119-123
Author(s):  
N. M. Gafurova ◽  
E. V. Shikh ◽  
O. D. Ostroumova
Keyword(s):  
Heart Failure ◽  
Diuretic Therapy ◽  
Individual Characteristics ◽  
Loop Diuretics ◽  
Duration Of Action ◽  
Important Place ◽  
Genetic Characteristics ◽  
Genes Encoding ◽  
The Individual ◽  
High Bioavailability

Optimizing diuretic therapy in patients with chronic heart failure is a complicated problem with many unresolved questions. Diuretics take an important place in the treatment of heart failure, which are used in almost 80% of cases. Currently, there are not enough clinical studies, which comparative effectiveness of loop diuretics, as well as studies aimed at personalizing diuretic therapy. Torasemide has several advantages over other loop diuretics; high bioavailability, longer half-life and duration of action provide predictable diuresis. The presence of favorable neurohormonal effects, consisting in a decrease of sympathetic activity and inhibition of the renin-angiotensin-aldosterone system, leads to the fact that hypokalemia rarely occurs. In addition, torasemide slows development of myocardial fibrosis and fosters reverse ventricular remodelling. The use of personalization methods is one of the ways to increase the efficiency and safety of pharmacotherapy with diuretics. The polymorphism of genes encoding systems of biotransformation and transporters of drug is an important factor that determines the individual characteristics of a patient. Pharmacogenetics of torasemide may be of significant importance for pharmacokinetics and pharmacodynamics, influencing the intensity of the diuretic effect and side effects. The clearance of torasemide after oral administration may vary by 47% due to genetic characteristics: the participation of the OATP1B1 polymorphism is approximately 15.5%, the CYP2C9 polymorphism is 20%, and the OAT1 and OAT4 polymorphisms are 10%. Due to the significant differences in the pharmacokinetics of torasemide, further study of the pharmacodynamic characteristics of torasemide in patients with genetic polymorphism is necessary.

Abstract 187: Loop Diuretic Therapy in Acute Decompensated Heart Failure among Premier Hospitals

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Behnood Bikdeli ◽  
Kelly Strait ◽  
Kumar Dharmarajan ◽  
Chohreh Partovian ◽  
Nancy Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Loop Diuretics ◽  
High Rate ◽  
Average Daily Dose ◽  
Duration Of Therapy ◽  
Daily Dose ◽  
Hospital Use

Background: Although loop diuretics are frequently used for patients with heart failure (HF), little is known about the variation in patterns of diuretic therapy in US hospitals. We sought to describe such treatment patterns among a diverse group of hospitals. Methods: We studied HF hospitalizations occurring during 2009-10 in Premier Inc. hospitals participating in a collaborative project to pool administrative and charge data, which includes information about drug types, average daily dose, and duration of therapy. We excluded hospitals with less than 25 HF hospitalizations. For ease of comparison, all diuretic doses were converted to bioequivalent doses of intravenous (IV) furosemide: 40mg IV furosemide ∼ 80mg oral furosemide ∼ 20mg (oral or IV) torsemide ∼ 1mg (oral or IV) bumetanide. Summary statistics were calculated. Results: Among 366 studied hospitals (264,675 HF hospitalizations), use of any loop diuretic had an interquartile range (IQR) from 92% to 96% (median: 94%). At the hospital level, the average daily dose IQR varied from 45mg to 64 mg (median: 55 mg) and the median duration of therapy was 4 days (IQR: 4 to 4; median: 4), as was the median length of stay. The IQR for use of furosemide varied from 89% to 94% (median: 92%), and its median average daily dose had an IQR from 40mg to 60 mg (median: 53 mg). Hospital use of bumetanide had an IQR from 2% to 11%, and hospital use of torsemide had an IQR from 0% to 4% (medians of 5% and 1%, respectively). The variation in median average daily dose for bumetanide and torsemide was greater than for furosemide (bumetanide IQR: 79mg to 127 mg, with median of 89 mg; torsemide IQR: 53mg to 120 mg, with median of 80 mg). Use of IV diuretics on the last day before home discharge had an IQR from 16% to 33% (median: 24%) across hospitals. Conclusion: US hospitals administer loop diuretics, particularly furosemide, to the vast majority of HF inpatients. The duration and daily dosage of therapy was similar across most hospitals. In contrast, a minority of hospitals used bumetanide and torsemide for several patients. The daily dosage of these agents showed more marked variation. We observed a high rate of intravenous diuretic use on the last day of hospitalization, with considerable variation across hospitals.

scholarly journals ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

2019 ◽  
pp. 61-63
Author(s):  
PRUDENCE A RODRIGUES ◽  
SOUMYA GK ◽  
NADIA GRACE BUNSHAW ◽  
SARANYA N ◽  
SUJITH K ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Injury ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Loop Diuretics ◽  
Contributing Factors ◽  
The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

scholarly journals Diuretic treatment in chronic heart failure

2016 ◽  
Vol 11 (2) ◽  
pp. 155-159
Author(s):  
Camelia C. DIACONU ◽  
◽  
Alice BĂLĂCEANU ◽  
Mihaela Adela IANCU ◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Diuretic Therapy ◽  
Medical Science ◽  
Clinical Manifestations ◽  
Public Health Problem ◽  
Developed Countries ◽  
The Body ◽  
Major Public Health Problem ◽  
Important Place ◽  
Central Pillar

Heart failure is a major public health problem in developed countries. Many of the clinical manifestations of heart failure are due to congestion and fluid retention, therefore diuretic therapy occupied for a long time an important place in the management of these patients. All diuretics increase the excretion of water from the body, each of the classes of diuretics achieving this effect in a distinct manner. Given the magnitude of their effect, loop diuretics are the central pillar of diuretic therapy in many patients with heart failure. Resistance to diuretic therapy is one of the management issues for medical science, which is looking for solutions.

scholarly journals Relationship between Volitional Regulation and Ethnic Identity

2019 ◽  
Vol 15 (3) ◽  
pp. 83-90 ◽  
Author(s):  
V.N. Shlyapnikov
Keyword(s):  
Ethnic Identity ◽  
Individual Characteristics ◽  
Self Control ◽  
Self Assessment ◽  
Important Place ◽  
Positive Correlations ◽  
The Individual ◽  
And Behavior ◽  
The Relationship ◽  
Purpose In Life Test

The paper analyses the ethnocultural factors of volitional regulation from the cultural-historical perspective. A hypothesis is put forward about the relationship between the specifics of volitional regulation and national self-consciousness of the individual. The aim of the work is to study the relationship between ethnic identity and features of volitional regulation among representatives of various ethnic groups (Russians, Komis, Tuvans, Kabardians, Mari, Koreans). A total of 600 people aged 18 to 30 years took part in the study (the samples were gender balanced). To evaluate the individual characteristics of volitional regulation in the respondents, the following techniques were used: the Action Control Scale by J. Kuhl; the "Questionnaire for revealing the expression of self-control in the emotional sphere, activity and behavior"; the technique for self-assessment of volitional qualities; the Purpose in Life Test. The features of ethnic identity were evaluated using the “Types of Ethnic Identity” technique (by S.V. Ryzhova, G.U. Soldatova). The study revealed significant positive correlations between the intensity of volitional self-control and the overall score of volitional self-esteem and positive ethnicity in groups where nationality occupies an important place in the structure of the subject's self-consciousness (Tuvans, Koreans, Kabardians).

scholarly journals Mechanism and management of diuretic resistance in congestive heart failure

2012 ◽  
Vol 17 (1) ◽  
pp. 44-46
Author(s):  
Dipankar Chandra Nag ◽  
AKM Murshed ◽  
Rajashis Chakrabortty ◽  
Md Raziur Rahman
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Sodium Intake ◽  
Diuretic Therapy ◽  
Compensatory Hypertrophy ◽  
Loop Diuretics ◽  
Thick Ascending Limb ◽  
Diuretic Resistance ◽  
First Line Therapy ◽  
Advanced Stages

Diuretic drugs are used almost universally in patients with congestive heart failure, most frequently the potent loop diuretics. Despite their unproven effect on survival, their indisputable efficacy in relieving congestive symptoms makes them first line therapy for most patients. In the treatment of more advanced stages of heart failure diuretics may fail to control salt and water retention despite the use of appropriate doses. Diuretic resistance may be caused by decreased renal function and reduced and delayed peak concentrations of loop diuretics in the tubular fluid, but it can also be observed in the absence of these pharmacokinetic abnormalities. When the effect of a short acting diuretic has worn off, postdiuretic salt retention will occur during the rest of the day. Chronic treatment with a loop diuretic results in compensatory hypertrophy of epithelial cells downstream from the thick ascending limb and consequently its diuretic effect will be blunted. Strategies to overcome diuretic resistance include restriction of sodium intake, changes in dose, changes in timing, and combination diuretic therapy. DOI: http://dx.doi.org/10.3329/jdnmch.v17i1.12193 J. Dhaka National Med. Coll. Hos. 2011; 17 (01): 44-46

Torasemide in hypertension and heart failure: re-inventing loop diuretic therapy?

2021 ◽  
Vol 27 ◽  
Author(s):  
Athanasios Manolis ◽  
Manolis Kallistratos ◽  
Michael Doumas
Keyword(s):  
Heart Failure ◽  
Arterial Hypertension ◽  
European Society ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Loop Diuretics ◽  
Hypertensive Patients ◽  
Esc Guidelines ◽  
European Society Of Cardiology ◽  
First Time

: In heart failure (HF) patients, current European Society of Cardiology (ESC) guidelines recommends the use of three loop diuretics (furosemide, torasemide, bumetanide) in order to reduce HF hospitalizations but also to improve symptoms and exercise capacity in patients with signs and/or symptoms of congestion. In addition, for the first time in hypertensive patients, European Society of Hypertension (ESH) guidelines recommend the use of torasemide. This review aimed to summarize the mode of action of loop diuretics, to present their pharmacokinetic characteristics, and to discuss their place in the management of arterial hypertension and heart failure, with special emphasis however on torasemide.

Policy Problems

2017 ◽  
Author(s):  
Patrik Marier
Keyword(s):  
Policy Design ◽  
Wicked Problems ◽  
Individual Characteristics ◽  
Policy Feedback ◽  
Theoretical Frameworks ◽  
Important Place ◽  
Policy Problem ◽  
The Individual ◽  
The Right ◽  
Policy Problems

We frequently employ analogies such as a leaking roof or finishing last in a ranking to illustrate that there is a serious problem requiring attention. Unfortunately, policy realities are far more complex and less obvious since policymakers do not benefit from objective measures or clear signals akin to having water dripping over their head to indicate the presence of a problem. In fact, they face a plethora of policy actors constantly engaged in defining policy problems for them based on competing frames of references. The term “policy problems” evokes questions of what makes a social issue a policy problem, but it also raises questions regarding whether problems can actually be solved via a public response and how. Policy problems occupy a crucial role in policy studies, if not for the simple reason that political authorities are unlikely to alter or create policies without the presence of problems. As such, policy problems occupy an important place in popular theoretical frameworks frequently employed in the field of public policy. The formulation of policy problems is at the heart of the punctuated-equilibrium theory since these can result in the creation of new political coalitions seeking transformative policy change. In the social construction of target populations approach, the ways in which the public perceives particular subgroups or subpopulations dictate our understanding of policy problems and the types of instruments to deploy. Frameworks for policy feedback assume that current policies structure the formulation of policy problems along the lines of altering existing policies. In the multiple-streams theoretical framework, policy problems are part of a toolkit used to validate the use of already made solutions by policy entrepreneurs seeking the right opportunity for implementation. A thorough treatment and analysis of policy problems exist within the policy design literature. Scholars operating within this tradition have emphasized the individual characteristics of policy problems and, as importantly, how these matter when it is time to enact solutions. Characteristics of problems, such as causality and severity, are key elements in the identification and formulation of policy problems and their likelihood to feature prominently in the policy agenda of governmental actors. Additional elements, such as the divisibility of policy problems and the extent to which these problems can be monetarized, matter in assessing the possibility of enacting solutions. This raises the fundamental question of whether policy problems can actually be resolved. Mature policies are the norm in industrialized countries, and these are increasingly subject to international agreements. Consequently, there are, for example, many more interdependencies, which have led to the reemergence of wicked-problems analyses. However, a substantial number of contributions have associated complexity with wicked problems, raising questions surrounding their intrinsic qualities and the danger of conceptual stretching.

scholarly journals In dogs with congestive heart failure, is torasemide superior to furosemide as a first line diuretic treatment?

2020 ◽  
Vol 5 (4) ◽  
Author(s):  
Leo Packham
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Research Question ◽  
Individual Case ◽  
Clinical Expertise ◽  
First Line ◽  
Bottom Line ◽  
Duration Of Action ◽  
The Individual ◽  
Randomised Controlled

PICO question In dogs with congestive heart failure, does the use of torasemide as a first line diuretic result in a superior survival time when compared to furosemide?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Five studies were critically appraised, they were all prospective randomised controlled trials Strength of evidence Moderate Outcomes reported There is currently a lack of studies looking at comparing furosemide directly with torasemide in patients with congestive heart failure. There are many similarly drawn conclusions from the studies: torasemide is not inferior to furosemide in the treatment of CHF, torasemide is comparable to furosemide at one tenth the dose (or less) and that torasemide may be more effective at diuresis than furosemide with a prolonged duration of action Conclusion There is currently no clear and obvious benefit for the use of torasemide, over furosemide, as a first line diuretic for dogs with congestive heart failure   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care

scholarly journals Under-recognition of heart failure in patients with atrial fibrillation and the impact of gender: a UK population-based cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rosita Zakeri ◽  
Ann D. Morgan ◽  
Varun Sundaram ◽  
Chloe Bloom ◽  
John G. F. Cleland ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Surrogate Marker ◽  
Population Based ◽  
Loop Diuretics ◽  
The Impact

Abstract Background Patients with atrial fibrillation (AF) complicated by heart failure (HF) have a poor prognosis. We investigated whether long term loop-diuretic therapy in patients with AF and no known diagnosis of HF, as a potential surrogate marker of undiagnosed HF, is also associated with worse outcomes. Methods Adults with incident AF were identified from UK primary and secondary care records between 2004 and 2016. Repeat prescriptions for loop diuretics, without a diagnosis of HF or documented non-cardiac indication, were classified as ‘isolated’ loop diuretic use. Results Amongst 124,256 people with incident AF (median 76 years, 47% women), 22,001 (17.7%) had a diagnosis of HF, and 22,325 (18.0%) had isolated loop diuretic use. During 2.9 (LQ-UQ 1–6) years’ follow-up, 12,182 patients were diagnosed with HF (incidence rate 3.2 [95% CI 3.1–3.3]/100 person-years). Of these, 3999 (32.8%) had prior isolated loop diuretic use, including 31% of patients diagnosed with HF following an emergency hospitalisation. The median time from AF to HF diagnosis was 3.6 (1.2–7.7) years in men versus 5.1 (1.8–9.9) years in women (p = 0.0001). In adjusted models, patients with isolated loop diuretic use had higher mortality (HR 1.42 [95% CI 1.37–1.47], p < 0.0005) and risk of HF hospitalisation (HR 1.60 [95% CI 1.42–1.80], p < 0.0005) than patients with no HF or loop diuretic use, and comparably poor survival to patients with diagnosed HF. Conclusions Loop diuretics are commonly prescribed to patients with AF and may indicate increased cardiovascular risk. Targeted evaluation of these patients may allow earlier HF diagnosis, timely intervention, and better outcomes, particularly amongst women with AF, in whom HF appears to be under-recognised and diagnosed later than in men.

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