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Pediatric Nephrology (Berlin, Germany) Sep 2021The use of diuretics is extremely frequent in sick neonates, the more so in very premature newborn infants. The use of diuretics in patients whose kidney function is... (Review)
Review
The use of diuretics is extremely frequent in sick neonates, the more so in very premature newborn infants. The use of diuretics in patients whose kidney function is immature necessitates a thorough knowledge of renal developmental physiology and pathophysiology. This review presents the basic aspects of body fluid homeostasis in the neonate, discusses the development of kidney function, and describes the mechanisms involved in electrolyte and water reabsorption along the nephron. Diuretics are then classified according to the site of their action on sodium reabsorption. The use of diuretics in sodium-retaining states, in oliguric states, in electrolyte disorders, and in arterial hypertension, as well as in a few specific disorders, is presented. Common and specific adverse effects are discussed. Recommended dosages for the main diuretics used in the neonatal period are given. New developments in diuretic therapy are briefly mentioned.
Topics: Diuretics; Humans; Infant, Newborn; Infant, Premature
PubMed: 33481099
DOI: 10.1007/s00467-021-04921-3 -
Nederlands Tijdschrift Voor Geneeskunde May 2023Loop diuretics are the cornerstone of the treatment of volume overload in decompensated heart failure. However, often complete decongestion cannot be achieved rapidly... (Randomized Controlled Trial)
Randomized Controlled Trial
Loop diuretics are the cornerstone of the treatment of volume overload in decompensated heart failure. However, often complete decongestion cannot be achieved rapidly with loop diuretics alone, partly due to compensatory upregulation of sodium resorption at other parts of the nephron. These compensatory mechanisms can be antagonized by using a combination of diuretics. In earlier research, a number of those combinations have been investigated, but no diuretic combination has been proven to be both efficient and safe yet. A recent multicenter, double-blind, randomized, placebo-controlled study - performed by Mullens et al. in 2022 - investigated adding acetazolamide (Diamox) to loop diuretics in patients with decompensated heart failure. They found that a higher rate of decongestion was achieved with the addition of acetazolamide without seemingly more side effects. The addition of acetazolamide can be considered in the treatment of decompensated heart failure.
Topics: Humans; Diuretics; Acetazolamide; Sodium Potassium Chloride Symporter Inhibitors; Heart Failure; Combined Modality Therapy
PubMed: 37257097
DOI: No ID Found -
NeoReviews Mar 2022Understanding physiologic water balance and homeostasis mechanisms in the neonate is critical for clinicians in the NICU as pathologic fluid accumulation increases the... (Review)
Review
Understanding physiologic water balance and homeostasis mechanisms in the neonate is critical for clinicians in the NICU as pathologic fluid accumulation increases the risk for morbidity and mortality. In addition, once this process occurs, treatment is limited. In this review, we will cover fluid homeostasis in the neonate, explain the implications of prematurity on this process, discuss the complexity of fluid accumulation and the development of fluid overload, identify mitigation strategies, and review treatment options.
Topics: Diuretics; Homeostasis; Humans; Infant, Newborn; Water-Electrolyte Balance; Water-Electrolyte Imbalance
PubMed: 35229135
DOI: 10.1542/neo.23-3-e189 -
Current Pharmaceutical Design 2023Heart failure is a major problem in developed countries, leading to a high number of hospitalizations and healthcare costs. The most common symptom of heart failure is... (Review)
Review
Heart failure is a major problem in developed countries, leading to a high number of hospitalizations and healthcare costs. The most common symptom of heart failure is congestion, which is also the primary reason for hospitalization. Diuretics, particularly loop diuretics, are the cornerstone of the treatment of congestion. Likewise, there are other types of diuretics with different pathways of action, bioavailability profiles, adverse reactions, and effects on the cardiovascular and renal systems. Moreover, in recent years, new therapeutic alternatives have been proposed for challenging cases of diuretic resistance, such as ultrafiltration through peripheral access or peritoneal dialysis. The main objective of this article is to provide a step-guided approach to the management of congestion in patients with heart failure in order to guide the medical practice. Despite the significant amount of research published in recent years, there are no clear algorithms for managing acute heart failure. Diuretics remain the primary treatment of acute heart failure, and nephron blockade is key, but new therapies are emerging, and ongoing research is needed to develop better strategies for managing this condition.
Topics: Humans; Diuretics; Heart Failure; Ultrafiltration
PubMed: 37455461
DOI: 10.2174/1381612829666230714153404 -
Frontiers in Endocrinology 2023SGLT2 inhibitors (SGLT2i) are now the mainstay therapy for both diabetes and heart failure. publications, meta-analysis, and conference presentations of the eight... (Review)
Review
SGLT2 inhibitors (SGLT2i) are now the mainstay therapy for both diabetes and heart failure. publications, meta-analysis, and conference presentations of the eight SGLT2i Cardiovascular Outcomes trials (CVOTS) done in diabetic patients constantly echo that this class of drug decreases mortality, reduces cardiovascular events, and prevents heart failure and kidney disease. This review of medical agencies' SGLT2i analysis (FDA and EMA) helps to understand the reality of SGLT2i results in those trials, avoiding to consider observational and statistically undemonstrated endpoints as validated. They also confirmed the unique diuretic mode of action of SGLT2i, promoting osmotic diuresis, and its potential adverse events secondary to hypovolemia and hematocrit increase. They also support the understanding that the beliefs in SGLT2i morbi-mortality benefits are largely overstated mostly based on undemonstrated endpoints. Finally, it is clear that SGLT2i's antidiabetic action, secondary to its renal mode of action, plateaued after a few months and decreased strongly over time, questioning its long-term goal of maintaining diabetic patients' HbA1c below 7%. Also, this effect in patients with renal impairment is quasi null. We think that this review would be very helpful to every physician treating diabetic patients to better balance belief and reality of SGLT2i prescription effects.
Topics: Humans; Canagliflozin; Diabetes Mellitus, Type 2; Diuretics; Glucosides; Heart Failure; Observational Studies as Topic; Sodium-Glucose Transporter 2 Inhibitors
PubMed: 37547306
DOI: 10.3389/fendo.2023.1174692 -
Current Heart Failure Reports Oct 2022Progressive intravascular, interstitial, and alveolar fluid overload underlies the transition from compensated to acutely decompensated heart failure and loop diuretics... (Review)
Review
PURPOSE OF THE REVIEW
Progressive intravascular, interstitial, and alveolar fluid overload underlies the transition from compensated to acutely decompensated heart failure and loop diuretics are the mainstay of treatment. Adverse effects and resistance to loop diuretics received much attention while the contribution of a depressed cardiac output to diuretic resistance was downplayed.
RECENT FINDINGS
Analysis of experience with positive inotropic agents, especially dobutamine, indicates that enhancement of cardiac output is not consistently associated with increased renal blood flow. However, urinary output and renal sodium excretion increase likely due to dobutamine-mediated decrease in renal and systemic reduced activation of sympathetic nervous- and renin-angiotensin-aldosterone system. Mechanical circulatory support with left ventricular assist devices ascertained the contribution of low cardiac output to diuretic resistance and the pathogenesis and progression of kidney disease in acutely decompensated heart failure. Diuretic resistance commonly occurs in acutely decompensated heart failure. However, failure to resolve fluid overload despite high doses of loop diuretics should alert to the presence of a low cardiac output state.
Topics: Cardiac Output, Low; Diuretics; Dobutamine; Heart Failure; Humans; Sodium; Sodium Potassium Chloride Symporter Inhibitors; Water-Electrolyte Imbalance
PubMed: 36045314
DOI: 10.1007/s11897-022-00573-y -
Pediatric Nephrology (Berlin, Germany) Dec 2021Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in...
BACKGROUND
Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated.
METHODS
This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated.
RESULTS
Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders.
CONCLUSIONS
Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
Topics: Acute Kidney Injury; Birth Weight; Diuretics; Hospital Mortality; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Retrospective Studies
PubMed: 34019153
DOI: 10.1007/s00467-021-05132-6 -
European Heart Journal Jun 2023
Topics: Humans; Diuretics; Acetazolamide; Bicarbonates; Heart Failure; Biomarkers
PubMed: 37160825
DOI: 10.1093/eurheartj/ehad209 -
Mini Reviews in Medicinal Chemistry 2021Over the years, the development of bioactive heterocycles has aroused the interest of the scientific community, because in general, these heterocycles are strategic in... (Review)
Review
Over the years, the development of bioactive heterocycles has aroused the interest of the scientific community, because in general, these heterocycles are strategic in maintaining life. Research into bioactive heterocycles is associated with the development of methods of synthesis and the biological evaluation of different nuclei. In consequence, there has been a growing interest in the nucleus of fused pyrimidine, which has diversified pharmacological activities, including diuretic, antimicrobial, antifolate, tyrosine kinase, anti-inflammatory, anticancer, anthelminthic, and antiviral activities. This review focuses on describing a diverse set of structures derived from pyrimido[4,5-d]pyrimidines and contemplates the main bioactivities of these nuclei.
Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Antineoplastic Agents; Diuretics; Folic Acid Antagonists; Humans; Protein-Tyrosine Kinases; Pyrimidines
PubMed: 33605856
DOI: 10.2174/1389557521666210219160115 -
Biomedicine & Pharmacotherapy =... Jan 2023Edema caused by kidney disease is called renal edema. Edema is a common symptom of many human kidney diseases. Patients with renal edema often need to take... (Review)
Review
Edema caused by kidney disease is called renal edema. Edema is a common symptom of many human kidney diseases. Patients with renal edema often need to take diuretics.However, After taking diuretics, patients with kidney diseases are prone to kidney congestion, decreased renal perfusion, decreased diuretics secreted by renal tubules, neuroendocrine system abnormalities, abnormal ion transporter transport, drug interaction, electrolyte disorder, and hypoproteinemia, which lead to ineffective or weakened diuretic use and increase readmission rate and mortality. The main causes and coping strategies of diuretic resistance in patients with kidney diseases were described in detail in this report. The common causes of DR included poor diet (electrolyte disturbance and hypoproteinemia due to patients' failure to limit diet according to correct sodium, chlorine, potassium, and protein level) and poor drug compliance (the patient did not take adequate doses of diuretics. true resistance occurs only if the patient takes adequate doses of diuretics, but they are not effective), changes in pharmacokinetics and pharmacodynamics, electrolyte disorders, changes in renal adaptation, functional nephron reduction, and decreased renal blood flow. Common treatment measures include increasing in the diuretic dose and/or frequency, sequential nephron blockade,using new diuretics, ultrafiltration treatment, etc. In clinical work, measures should be taken to prevent or delay the occurrence and development of DR in patients with kidney diseases according to the actual situation of patients and the mechanism of various causes. Currently, there are many studies on DR in patients with heart diseases. Although the phenomenon of DR in patients with kidney diseases is common, there is a relatively little overview of the mechanism and treatment strategy of DR in patients with kidney diseases. Therefore, this paper hopes to show the information on DR in patients with kidney diseases to clinicians and researchers and broaden the research direction and ideas to a certain extent.
Topics: Humans; Diuretics; Heart Failure; Kidney Diseases; Kidney; Sodium; Water-Electrolyte Imbalance; Edema; Drug Resistance
PubMed: 36473405
DOI: 10.1016/j.biopha.2022.114058