Authors: Michael M Braun, Craig H Barstow, Natasha J Pyzocha...

Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Treatment is based on symptoms and underlying causes. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). A combination of these therapies may be needed based on the presentation. Hypertonic saline is used to treat severe symptomatic hyponatremia. Medications such as vaptans may have a role in the treatment of euvolemic and hypervolemic hyponatremia. The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit.

Topics: Diagnosis, Differential; Diuresis; Fluid Therapy; Humans; Hypernatremia; Hyponatremia; Isotonic Solutions; Saline Solution, Hypertonic; Sodium

PubMed: 25822386
DOI: No ID Found

Authors: Jeroen Dauw, Kristina Charaya, Małgorzata Lelonek...

BACKGROUND

The use of urinary sodium to guide diuretics in acute heart failure is recommended by experts and the most recent European Society of Cardiology guidelines. However, there are limited data to support this recommendation. The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure and signs of volume overload.

METHODS

ENACT-HF was an international, multicenter, open-label, pragmatic, 2-phase study, comparing the current standard of care of each center with a standardized diuretic protocol, including urinary sodium to guide therapy. The primary end point was natriuresis after 1 day. Secondary end points included cumulative natriuresis and diuresis after 2 days of treatment, length of stay, and in-hospital mortality. All end points were adjusted for baseline differences between both treatment arms.

RESULTS

Four hundred one patients from 29 centers in 18 countries worldwide were included in the study. The natriuresis after 1 day was significantly higher in the protocol arm compared with the standard of care arm (282 versus 174 mmol; adjusted mean ratio, 1.64; <0.001). After 2 days, the natriuresis remained higher in the protocol arm (538 versus 365 mmol; adjusted mean ratio, 1.52; <0.001), with a significantly higher diuresis (5776 versus 4381 mL; adjusted mean ratio, 1.33; <0.001). The protocol arm had a shorter length of stay (5.8 versus 7.0 days; adjusted mean ratio, 0.87; =0.036). In-hospital mortality was low and did not significantly differ between the 2 arms (1.4% versus 2.0%; =0.852).

CONCLUSIONS

A standardized natriuresis-guided diuretic protocol to guide decongestion in acute heart failure was feasible, safe, and resulted in higher natriuresis and diuresis, as well as a shorter length of stay.

Topics: Humans; Diuretics; Natriuresis; Heart Failure; Diuresis; Sodium; Sodium Potassium Chloride Symporter Inhibitors

PubMed: 38179728
DOI: 10.1161/CIRCHEARTFAILURE.123.011105

Review

Authors: Matteo Vitali, Mario Fontana, Andrea De Giorgi...

The present systematic review is aimed at evaluating the diuretic effects determined according to the natural mineral water consumption on healthy individuals. This systematic review has been performed following the guidelines of the PRISMA (preferred reporting items for systematic reviews and meta-analyses) Statement, investigating PubMed, Scopus, Web of Science and Cochrane Library from inception to November 2022. Studies performed both on animals and on humans were considered. After screening, a total of 12 studies have been identified. Of these, 11 studies were performed in Italy and 1 in Bulgaria. The time range of publication is very wide, ranging from 1962 to 2019 for human studies and from 1967 to 2001 for animal studies. All the included studies found an increase in diuresis determined according to the consumption of natural mineral water, in some cases after just one administration of the tested water. However, the quality of the studies is not so high, especially for the research conducted many years ago. Thus, it would be desirable to carry out new clinical studies using more appropriate methodological approaches and more refined methods of statistical data processing.

Topics: Humans; Mineral Waters; Diuresis; Bulgaria; Italy

PubMed: 37107810
DOI: 10.3390/ijerph20085527

Meta-Analysis Review

Authors: Yang Zhang, Aitor Coca, Douglas J Casa...

OBJECTIVES

Although ergogenic, acute caffeine ingestion may increase urine volume, prompting concerns about fluid balance during exercise and sport events. This meta-analysis evaluated caffeine induced diuresis in adults during rest and exercise.

DESIGN

Meta-analysis.

METHODS

A search of three databases was completed on November 1, 2013. Only studies that involved healthy adults and provided sufficient information concerning the effect size (ES) of caffeine ingestion on urine volume were included. Sixteen studies met the inclusion criteria, providing a total of 28 ESs for the meta-analysis. Heterogeneity was assessed using a random-effects model.

RESULTS

The median caffeine dosage was 300 mg. The overall ES of 0.29 (95% confidence interval (CI) = 0.11-0.48, p = 0.001) corresponds to an increase in urine volume of 109 ± 195 mL or 16.0 ± 19.2% for caffeine ingestion vs. non-caffeine conditions. Subgroup meta-analysis confirmed exercise as a strong moderator: active ES = 0.10, 95% CI = -0.07 to 0.27, p = 0.248 vs. resting ES = 0.54, 95% CI = 0.22-0.85, p = 0.001 (Cochran's Q, p = 0.019). Females (ES = 0.75, 95% CI = 0.38-1.13, p < 0.001) were more susceptible to diuretic effects than males (ES = 0.13, 95% CI = -0.05 to 0.31, p = 0.158) (Cochran's Q, p = 0.003).

CONCLUSIONS

Caffeine exerted a minor diuretic effect which was negated by exercise. Concerns regarding unwanted fluid loss associated with caffeine consumption are unwarranted particularly when ingestion precedes exercise.

Topics: Adult; Caffeine; Central Nervous System Stimulants; Diuresis; Exercise; Female; Humans; Male; Models, Statistical; Rest; Water-Electrolyte Balance

PubMed: 25154702
DOI: 10.1016/j.jsams.2014.07.017

Review

Authors: B D Rose

Topics: Biological Transport; Cardiomyopathy, Dilated; Diuresis; Diuretics; Edema; Humans; Kidney; Male; Middle Aged; Natriuresis; Water-Electrolyte Balance

PubMed: 2002648
DOI: 10.1038/ki.1991.43

Authors: Edwin K Jackson, Elizabeth V Menshikova, Vladimir B Ritov...

8-Aminoguanine and 8-aminoguanosine (via metabolism to 8-aminoguanine) are endogenous 8-aminopurines that induce diuresis, natriuresis, and glucosuria by inhibiting purine nucleoside phosphorylase (PNPase); moreover, both 8-aminopurines cause antikaliuresis by other mechanisms. Because 8-aminoinosine and 8-aminohypoxanthine are structurally similar to 8-aminoguanosine and 8-aminoguanine, respectively, we sought to define their renal excretory effects. First, we compared the ability of 8-aminoguanine, 8-aminohypoxanthine, and 8-aminoinosine to inhibit recombinant PNPase. These compounds inhibited PNPase with a potency order of 8-aminoguanine > 8-aminohypoxanthine = 8-aminoinosine. Additional studies showed that 8-aminoinosine is a competitive substrate that is metabolized to a competitive PNPase inhibitor, namely 8-aminohypoxanthine. Administration of each 8-aminopurine (33.5 µmol/kg) reduced the guanine-to-guanosine and hypoxanthine-to-inosine ratios in urine, a finding confirming their ability to inhibit PNPase in vivo. All three 8-aminopurines induced diuresis, natriuresis, and glucosuria; however, the glucosuric effects of 8-aminohypoxanthine and 8-aminoinosine were less pronounced than those of 8-aminoguanine. Neither 8-aminohypoxanthine nor 8-aminoinosine altered potassium excretion, whereas 8-aminoguanine caused antikaliuresis. In vivo administration of 8-aminoinosine increased 8-aminohypoxanthine excretion, indicating that 8-aminohypoxanthine mediates, in part, the effects of 8-aminoinosine. Finally, 8-aminohypoxanthine was metabolized to 8-aminoxanthine by xanthine oxidase. Using ultraperformance liquid chromatography-tandem mass spectrometry, we identified 8-aminoinosine as an endogenous 8-aminopurine. In conclusion, 8-aminopurines have useful pharmacological profiles. To induce diuresis, natriuresis, glucosuria, and antikaliuresis, 8-aminoguanine (or its prodrug 8-aminoguanosine) would be preferred. If only diuresis and natriuresis, without marked glucosuria or antikaliuresis, is desired, 8-aminohypoxanthine or 8-aminoinosine might be useful. Finally, here we report the in vivo existence of another pharmacologically active 8-aminopurine, namely 8-aminoinosine. SIGNIFICANCE STATEMENT: Here, we report that a family of 8-aminopurines affects renal excretory function: effects that may be useful for treating multiple diseases including hypertension, heart failure, and chronic kidney disease. For diuresis and natriuresis accompanied by glucosuria and antikaliuresis, 8-aminoguanine (or its prodrug 8-aminoguanosine) would be useful; if only diuresis and natriuresis is called for, 8-aminohypoxanthine or 8-aminoinosine would be useful. Previously, we identified 8-aminoguanine and 8-aminoguanosine as endogenous 8-aminopurines; here, we extend the family of endogenous 8-aminopurines to include 8-aminoinosine.

Topics: Humans; Diuresis; Diuretics; Glycosuria; Natriuresis; Prodrugs; Purine-Nucleoside Phosphorylase

PubMed: 35609923
DOI: 10.1124/jpet.122.001221

Review

Authors: Hasan K Siddiqi, Zachary L Cox, Lynne W Stevenson...

Diuresis to achieve decongestion is a central aim of therapy in patients hospitalized for acute decompensated heart failure (ADHF). While multiple approaches have been tried to achieve adequate decongestion rapidly while minimizing adverse effects, no single diuretic strategy has shown superiority, and there is a paucity of data and guidelines to utilize in making these decisions. Observational cohort studies have shown associations between urine sodium excretion and outcomes after hospitalization for ADHF. Urine chemistries (urine sodium ± urine creatinine) may guide diuretic titration during ADHF, and multiple randomized clinical trials have been designed to compare a strategy of urine chemistry-guided diuresis to usual care. This review will summarize current literature for diuretic monitoring and titration strategies, outline evidence gaps, and describe the recently completed and ongoing clinical trials to address these gaps in patients with ADHF with a particular focus on the utility of urine sodium-guided strategies.

Topics: Humans; Heart Failure; Diuresis; Sodium; Diuretics; Acute Disease

PubMed: 39128947
DOI: 10.1007/s10741-024-10424-8

Review

Authors: Hartmut Osswald, Jürgen Schnermann

This chapter describes the effects of the natural methylxanthines caffeine and theophylline on kidney function. Theophylline in particular was used traditionally to increase urine out put until more potent diuretics became available in the middle of the last century. The mildly diuretic actions of both methylxanthines are mainly the result of inhibition of tubular fluid reabsorption along the renal proximal tubule. Based upon the use of specific adenosine receptor antagonists and the observation of a complete loss of diuresis in mice with targeted deletion of the A1AR gene, transport inhibition by methylxanthines is mediated mainly by antagonism of adenosine A1 receptors (A1AR) in the proximal tubule. Methylxanthines are weak renal vasodilators, and they act as competitive antagonists against adenosine-induced preglomerular vasoconstriction. Caffeine and theophylline stimulate the secretion of renin by inhibition of adenosine receptors and removal of the general inhibitory brake function of endogenous adenosine. Since enhanced intrarenal adenosine levels lead to reduced glomerular filtration rate in several pathological conditions theophylline has been tested for its therapeutic potential in the renal impairment following administration of nephrotoxic substances such as radiocontrast media, cisplatin, calcineurin inhibitors or following ischemia-reperfusion injury. In experimental animals functional improvements have been observed in all of these conditions, but available clinical data in humans are insufficient to affirm a definite therapeutic efficacy of methylxanthines in the prevention of nephrotoxic or postischemic renal injury.

Topics: Animals; Caffeine; Contrast Media; Diuresis; Hemodynamics; Humans; Kidney; Natriuresis; Renin; Theophylline

PubMed: 20859805
DOI: 10.1007/978-3-642-13443-2_15

Review

Authors: Jennifer C Sullivan, Jennifer S Pollock

This year represents the fifth annual Data Diuresis session of the Water and Electrolyte Homeostasis (WEH) section of the American Physiological Society (APS) at the 2015 Experimental Biology meeting. As opposed to taking a single organ approach to the study of physiology, the WEH section employs an integrative approach to encompass how the different organ systems interact to regulate numerous physiological and pathophysiological processes. The goal of this minireview is to highlight the broad spectrum of research themes that were presented over the first five years of Data Diuresis. Presentation topics include (but are not limited to) oxidative stress, inflammation, obesity, pregnancy, and hypertension spanning the brain, heart and vasculature, and kidney. WEH researchers continue to impact and help drive the direction of physiological research across multiple disciplines, leaving us excited to see what the next five years of Data Diuresis will bring.

Topics: Animals; Diuresis; Evidence-Based Medicine; Humans; Models, Biological; Water-Electrolyte Balance

PubMed: 25855306
DOI: 10.1152/ajpregu.00107.2015

Natriuresis, Diuresis, and Volume Changes in Diabetics With Heart Failure With Preserved Ejection Fraction: Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Natriuretic Peptides.

Authors: J Silva Enciso

Topics: Diabetes Mellitus; Diuresis; Glucose; Heart Failure; Humans; Natriuresis; Natriuretic Peptides; Sodium; Sorbitol; Stroke Volume

PubMed: 32805147
DOI: 10.1161/JAHA.120.017666