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Acta Medica Portuguesa Mar 2023Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute... (Review)
Review
Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute heart failure are caused by congestive conditions, not all patients have a congestive phenotype, reflecting the complexity of a process with multiple pathophysiological pathways. The use of diuretics, usually loop diuretics, is the mainstay of treatment for congestion. However, many patients develop resistance, thus constituting a challenge with no consensual solution to date, despite extensive debate over the years. Despite its frequent use in clinical practice, the co-administration of albumin and furosemide remains controversial in the management of patients with acute heart failure, hypoalbuminemia, and diuretic resistance. This review addresses the pathophysiological mechanisms of congestion in patients with acute heart failure and explores the theoretical basis that supports the co-administration of albumin and furosemide in this clinical context. It is intended to clarify the potential benefit of the combined approach in this specific population and identify possible gaps in the literature that could be the subject of future studies.
Topics: Humans; Furosemide; Diuretics; Heart Failure; Sodium Potassium Chloride Symporter Inhibitors; Albumins
PubMed: 36762993
DOI: 10.20344/amp.17714 -
British Journal of Hospital Medicine... Dec 2023Thiazide diuretics exert a natriuretic and diuretic effect by inhibiting sodium reabsorption in the distal convoluted tubule. Furthermore, thiazide diuretics affect...
Thiazide diuretics exert a natriuretic and diuretic effect by inhibiting sodium reabsorption in the distal convoluted tubule. Furthermore, thiazide diuretics affect renal calcium handling by increasing calcium reabsorption, leading to hypocalciuria. The effect that thiazide diuretics exert on parathyroid hormone secretion is controversial. Some studies found parathyroid hormone levels were suppressed with the use of thiazide diuretics, while others found that thiazides were associated with initial parathyroid hormone suppression followed by raised parathyroid hormone levels. This makes the relationship between thiazide diuretics and primary hyperparathyroidism interesting. If a patient is taking thiazide diuretics, this may make it harder to establish the aetiology of hypercalcaemia and may unmask normocalcaemic or mild primary hyperparathyroidism. Thiazide diuretics may have a beneficial role in the diagnosis of patients with concomitant hyperparathyroidism and hypercalciuria by distinguishing secondary hyperparathyroidism caused by hypercalciuria from normocalcaemic primary hyperparathyroidism. In addition, thiazide diuretics may have a role in managing patients with primary hyperparathyroidism who have an indication for parathyroidectomy in view of significant hypercalciuria, but are unfit for surgery.
Topics: Humans; Sodium Chloride Symporter Inhibitors; Calcium; Hyperparathyroidism, Primary; Hypercalciuria; Diuretics; Parathyroid Hormone
PubMed: 38153014
DOI: 10.12968/hmed.2023.0228 -
JACC. Heart Failure Dec 2021The increasing burden of heart failure (HF) and emerging knowledge regarding chloride as a prognostic marker in HF have increased the interest in the pathophysiology and... (Review)
Review
The increasing burden of heart failure (HF) and emerging knowledge regarding chloride as a prognostic marker in HF have increased the interest in the pathophysiology and interactions of chloride abnormalities with HF-related factors and treatments. Chloride is among the major electrolytes that play a unique role in fluid homeostasis and is associated with cardiorenal and neurohormonal systems. This review elucidates the role of chloride in the pathophysiology of HF, evaluates the effects of treatment on chloride (eg, diuretic agents cause higher urinary chloride excretion and consequently serum hypochloremia), and discusses recent evidence for the association between chloride levels and mortality.
Topics: Chlorides; Diuretics; Electrolytes; Heart Failure; Humans; Water-Electrolyte Imbalance
PubMed: 34857174
DOI: 10.1016/j.jchf.2021.07.006 -
Cardiology Journal 2022Current hypertension guidelines suggest various strategies to reduce blood pressure levels, thereby reducing cardiovascular events: combinations of drugs with different...
Current hypertension guidelines suggest various strategies to reduce blood pressure levels, thereby reducing cardiovascular events: combinations of drugs with different mechanisms of action, such as an angiotensin converting enzyme inhibitors (ACEIs) and a diuretic, are the cornerstone of the modern treatment of hypertension, also as initial therapy. Among ACEIs, zofenopril has been shown to be effective in the management of hypertension both as monotherapy and in combination with a diuretic: zofenopril/hydrochlorothiazide fixed dose combination is particularly useful to improve treatment adherence through simplification of treatment regimen. Moreover, thanks to the sulfhydryl group, zofenopril has some peculiar properties (higher lipophilicity and tissue penetration, lower bradykinin-dependent effect, higher affinity for, and more persistent binding to, tissue ACE, significant antioxidant effect), which may account for the cardioprotective effects of the drug demonstrated in both pre-clinical studies and randomized clinical trials. The positive impact of zofenopril on clinical outcomes has been extensively documented by the SMILE program, including several clinical trials in patients with different conditions of myocardial ischemia treated with zofenopril: the results of the SMILE program, demonstrating the benefits of zofenopril vs. placebo and other ACEIs, emphasize the importance of a differentiated approach to patients with ischemic heart disease, based on a careful choice of the adopted agent, in order to improve the overall impact of pharmacological treatment on clinical outcomes.
Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Captopril; Diuretics; Humans; Hypertension; Myocardial Ischemia
PubMed: 34622438
DOI: 10.5603/CJ.a2021.0113 -
Cardiorenal Medicine 2023Acute decompensated heart failure (ADHF) has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on... (Review)
Review
Acute decompensated heart failure (ADHF) has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on healthcare systems worldwide. Hospitalization for ADHF is primarily driven by congestion, with intravenous loop diuretics representing the cornerstone of therapy. However, it is well described that a significant subset of patients is discharged with residual fluid overload. While the cause of the incomplete decongestion is multifactorial, the development of diuretic resistance is a well-characterized contributing factor with consequent poor outcomes. Moreover, the therapeutic response to diuretics is known to lack predictability. Extracorporeal ultrafiltration (a mechanical pump-driven therapy) has emerged as an option to overcome shortcomings of the diuretics. It allows clinicians to customize the volume and the rate of fluid removal to the needs and clinical characteristics of the patients. The results of the currently available studies indicate that this therapy is associated with more efficient fluid and sodium removal compared to medical therapy, hence leading to reduction in the rate of readmissions and a potential salutary impact on the financial burden associated with the care of these patients. While isolated ultrafiltration can be performed by conventional machines used for renal replacement therapy, the advent of simplified, portable, and user-friendly devices that are specifically designed for extracorporeal ultrafiltration therapy has further enhanced the interest in this therapeutic modality and increased the potential for its more widespread use. Further, development in this direction through device miniaturization may extend the horizons of indications and the applicability of this therapy even in the ambulatory settings.
Topics: Humans; Ultrafiltration; Heart Failure; Diuretics; Renal Replacement Therapy; Hospitalization
PubMed: 36323267
DOI: 10.1159/000527204 -
BMB Reports Apr 2023Maintaining internal homeostasis and regulating innate behaviors are essential for animal survival. In various animal species, a highly conserved neuroendocrine system... (Review)
Review
Maintaining internal homeostasis and regulating innate behaviors are essential for animal survival. In various animal species, a highly conserved neuroendocrine system integrates sensory inputs and regulates physiological responses to environmental and internal changes. Diuretic hormones 44 and 31, which are homologs of mammalian corticotropin-releasing factor (CRF) and calcitonin gene-related peptide (CGRP), respectively, control body fluid secretion in Drosophila. These neuropeptides and their receptors have multiple physiological roles, including the regulation of body-fluid secretion, sleep:wake cycle, internal nutrientsensing, and CO-dependent response. This review discusses the physiological and behavioral roles of DH44 and DH31 signaling pathways, consisting of neuroendocrine cells that secrete DH44 or DH31 peptides and their receptor-expressing organs. Further research is needed to understand the regulatory mechanisms of the behavioral processes mediated by these neuroendocrine systems. [BMB Reports 2023; 56(4): 209-215].
Topics: Animals; Drosophila; Drosophila Proteins; Diuretics; Neuropeptides; Hormones; Mammals
PubMed: 36977606
DOI: 10.5483/BMBRep.2023-0021 -
Nefrologia 2019
Topics: Acidosis, Lactic; Acute Kidney Injury; Aged; Contraindications, Drug; Diuretics; Female; Humans; Hypoglycemic Agents; Male; Metformin; Renal Dialysis
PubMed: 31208831
DOI: 10.1016/j.nefro.2019.03.005 -
Current Opinion in Nephrology and... Sep 2022Existing guidelines offer little direction about the use of thiazide and loop diuretics in patients with chronic kidney disease (CKD). This review summarizes recent... (Review)
Review
PURPOSE OF REVIEW
Existing guidelines offer little direction about the use of thiazide and loop diuretics in patients with chronic kidney disease (CKD). This review summarizes recent studies impacting indications and safety considerations for these agents in patients with CKD.
RECENT FINDINGS
Chlorthalidone reduces blood pressure compared to placebo in patients with advanced CKD, challenging the belief that thiazide diuretics lose efficacy at lower glomerular filtration rates (GFR). Existing studies show no clear impact of thiazide or loop diuretic use on kidney or cardiovascular outcomes in patients with CKD. Sodium-glucose co-transporter type 2 (SGLT2) inhibitors have diuretic effects, but concomitant use of a diuretic does not diminish the preventive benefits of these agents against acute kidney injury (AKI). Despite theoretical concerns, thiazide diuretics likely do not worsen circulating vasopressin levels or cyst progression in polycystic kidney disease and may be useful for alleviating polyuria from tolvaptan. Diuretics cause multiple adverse effects, including electrolyte abnormalities, hemodynamic-mediated decrease in estimated GFR, and AKI.
SUMMARY
Recent evidence supports expanded indications for diuretics in patients with kidney disease, including chlorthalidone for hypertension in advanced CKD. Monitoring electrolytes and estimated GFR is critical to ensure patient safety when prescribing these agents for patients with CKD.
Topics: Acute Kidney Injury; Chlorthalidone; Diuretics; Humans; Hypertension; Renal Insufficiency, Chronic; Sodium Chloride Symporter Inhibitors; Sodium Potassium Chloride Symporter Inhibitors; Sodium-Glucose Transporter 2 Inhibitors; Thiazides
PubMed: 35894274
DOI: 10.1097/MNH.0000000000000814 -
Circulation. Heart Failure Nov 2021Animal models implicate FGF-23 (fibroblast growth factor-23) as a direct contributor to adverse cardiorenal interactions such as sodium avidity, diuretic resistance, and...
BACKGROUND
Animal models implicate FGF-23 (fibroblast growth factor-23) as a direct contributor to adverse cardiorenal interactions such as sodium avidity, diuretic resistance, and neurohormonal activation, but this has not been conclusively demonstrated in humans. Therefore, we aimed to evaluate whether FGF-23 is associated with parameters of cardiorenal dysfunction in humans with heart failure, independent of confounding factors.
METHODS
One hundred ninety-nine outpatients with heart failure undergoing diuretic treatment at the Yale Transitional Care Center were enrolled and underwent blood collection, and urine sampling before and after diuretics.
RESULTS
FGF-23 was associated with several metrics of disease severity such as higher home loop diuretic dose and NT-proBNP (N-terminal pro-B-type natriuretic peptide), and lower estimated glomerular filtration rate, serum chloride, and serum albumin. Multivariable analysis demonstrated no statistically significant association between FGF-23 and sodium avidity measured by fractional excretion of sodium, or proximal or distal tubular sodium reabsorption, either before diuretic administration or at peak diuresis (≥0.11 for all). Likewise, FGF-23 was not independently associated with parameters of diuretic resistance (diuretic excretion, cumulative urine and sodium output, and loop diuretic efficiency [≥0.33 for all]) or neurohormonal activation (plasma or urine renin [≥0.36 for all]). Moreover, the upper boundary of the 95% CI of all the partial correlations were ≤0.30, supporting the lack of meaningful correlations. FGF-23 was not associated with mortality in multivariable analysis (=0.44).
CONCLUSIONS
FGF-23 was not meaningfully associated with any cardiorenal parameter in patients with heart failure. While our methods cannot rule out a small effect, FGF-23 is unlikely to be a primary driver of cardiorenal interactions.
Topics: Aged; Aged, 80 and over; Diuresis; Diuretics; Female; Fibroblast Growth Factor-23; Heart Failure; Humans; Male; Middle Aged; Renin; Sodium; Sodium Potassium Chloride Symporter Inhibitors
PubMed: 34689571
DOI: 10.1161/CIRCHEARTFAILURE.121.008385 -
Aging Clinical and Experimental Research Nov 2023Previous studies have suggested that antihypertensive drugs may play a role in the treatment of osteoarthritis, but these studies may be limited by confounding factors... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Previous studies have suggested that antihypertensive drugs may play a role in the treatment of osteoarthritis, but these studies may be limited by confounding factors and lead to biased results. Therefore, we conducted a Mendelian randomization study to investigate the effects of blood pressure and antihypertensive drugs on osteoarthritis.
METHODS
We used published large-scale genome-wide association data and applied univariate and multivariate Mendelian randomization methods. The main analysis model was inverse variance weighting, and the reliability of the results was tested using MR-Egger intercept analysis, Cochran's Q test, and leave-one-out analysis. We comprehensively evaluated the relationship between systolic blood pressure, diastolic blood pressure, 12 antihypertensive drugs, and osteoarthritis. We also conducted verification in the independent queue of UK Biobank and built a simple linear regression model to obtain an independent comparison.
RESULTS
We found no evidence that systolic and diastolic blood pressure significantly affected osteoarthritis. However, among antihypertensive drugs, we observed a significant positive correlation between potassium-preserving diuretics and aldosterone antagonists and all osteoarthritis (OR: 0.560, 95% CI 0.406-0.772, P = 0.0004). Sensitivity analysis showed no horizontal pleiotropy or heterogeneity, and the leave-one-out analysis demonstrated the reliability of the results. This result was replicated with nominally statistical significance in the validation cohort and exhibited significant correlation in the linear regression analysis.
CONCLUSIONS
Our study suggested that controlling the protein targets of potassium-sparing diuretics and aldosterone antagonists may have beneficial results for osteoarthritis. These findings provide valuable medication strategies for the control of hypertension in patients with osteoarthritis.
Topics: Humans; Blood Pressure; Antihypertensive Agents; Genome-Wide Association Study; Mineralocorticoid Receptor Antagonists; Reproducibility of Results; Diuretics; Osteoarthritis; Potassium
PubMed: 37603265
DOI: 10.1007/s40520-023-02530-8