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Journal of the American Society of... Dec 2016
Topics: Anion Transport Proteins; Diuretics
PubMed: 27516234
DOI: 10.1681/ASN.2016070720 -
British Journal of Clinical Pharmacology May 2021Plasma renin activity (PRA) is regarded as a marker of sodium and fluid homeostasis in patients with primary hypertension. Whether effects of diuretics on PRA differ... (Meta-Analysis)
Meta-Analysis Review
AIMS
Plasma renin activity (PRA) is regarded as a marker of sodium and fluid homeostasis in patients with primary hypertension. Whether effects of diuretics on PRA differ according to class of diuretic, whether diuretics lead to a sustained increase in PRA, and whether changes in PRA relate to those in blood pressure (BP) is unknown. We performed a systematic review and meta-analysis of trials investigating the antihypertensive effects of diuretic therapy in which PRA and/or other biomarkers of fluid homeostasis were measured before and after treatment.
METHODS
Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials. Titles were firstly screened by title and abstract for relevancy before full-text articles were assessed for eligibility according to a predefined inclusion/exclusion criteria.
RESULTS
A total of 1684 articles were retrieved of which 61 met the prespecified inclusion/exclusion criteria. PRA was measured in 30/61 studies. Diuretics led to a sustained increase in PRA which was similar for different classes of diuretic (standardised mean difference [95% confidence interval] 0.481 [0.362, 0.601], 0.729 [0.181, 1.28], 0.541 [0.253, 0.830] and 0.548 [0.159, 0.937] for thiazide, loop, mineralocorticoid receptor antagonists/potassium-sparing and combination diuretics respectively, Q = 0.897, P = .826), and did not relate to the average decrease in blood pressure.
CONCLUSION
In antihypertensive drug trials, diuretics lead to a sustained increase in average PRA, which is similar across different classes of diuretic and unrelated to the average reduction in blood pressure.
Topics: Antihypertensive Agents; Blood Pressure; Diuretics; Humans; Hypertension; Renin
PubMed: 33085785
DOI: 10.1111/bcp.14597 -
Medicine Nov 2022Pulmonary hypertension (PH) is a severe form of pulmonary vascular disease that can lead to right heart failure (RHF). Nearly 2-thirds of patients with PH die within 5...
Pulmonary hypertension (PH) is a severe form of pulmonary vascular disease that can lead to right heart failure (RHF). Nearly 2-thirds of patients with PH die within 5 years. Studies suggest that a new diuretic medication, called tolvaptan (TLV), can be used to treat PH. However, there is still insufficient evidence to confirm its effectiveness. Therefore, we investigated the role of TLV in patients with PH. This retrospective study included 73 patients with PH hospitalized in Shanghai Pulmonary Hospital between November 2019 and March 2022. All patients received 7.5 to 15.0 mg of TLV for 3 to 21 days starting at admission, in addition to targeted drugs and traditional diuretic therapy. The outcomes included the blood pressure, urine and water intake volumes, electrolyte concentrations, and renal, liver, and cardiac function indexes before and after TLV treatment. In addition, we assessed the clinical symptoms and adverse reactions during the treatment. After TLV treatment, the water intake and urine volumes significantly increased, and body weight, diastolic blood pressure (DBP) and mean arterial pressure significantly decreased. Total bilirubin, direct bilirubin, N-terminal pro-brain natriuretic peptide, and serum uric acid (UA) levels after TLV treatment were significantly lower than before treatment. After TLV treatment, dyspnea significantly improved in 71 of 73 patients, and lower limb edema disappeared in 42 of 53 patients. No obvious adverse reactions occurred during the TLV treatment period. These results suggest that adding TLV to targeted drug and traditional diuretic therapies is effective for patients with PH. However, more data are required to support these findings.
Topics: Humans; Tolvaptan; Hypertension, Pulmonary; Retrospective Studies; Uric Acid; China; Diuretics; Bilirubin
PubMed: 36451399
DOI: 10.1097/MD.0000000000031587 -
African Journal of Traditional,... 2016Alpinia oxyphylla fruit (AOF, Yizhi in Chinese) is a well-known traditional Chinese medicine as an anti-diuretic agent and composed of two parts . seed and shell. These...
BACKGROUND
Alpinia oxyphylla fruit (AOF, Yizhi in Chinese) is a well-known traditional Chinese medicine as an anti-diuretic agent and composed of two parts . seed and shell. These two parts have different components, but the bioactivity differences of the two parts are not clear. This study aims to evaluate the different anti-diuretic effects of the seed and shell of AOF.
MATERIALS AND METHODS
The potential bioactive components were analyzed by UPLC-Q-TOF-MS. The diuretic and anti-diuretic activity was determined with saline-loads rats.
RESULTS
The results showed that the 200 mg/kg and 400mg/kg of SREAO displayed a short-time anti-diuretic activity 1h after administration and then a significant diuretic activity was being observed at 5-6 h in 400mg/kg group of SREAO. And the 400mg/kg doses of SREAO also showed a remarkable increase for electrolyte excretion of K. Three sesquiterpene compounds, namely oxyphyllol A (1), oxyphyllol B (2), and nootkatone (3) were identified from the active SREAO fraction by UHPLC-ESI-Q-TOF/MS.
CONCLUSION
The seed part of possessed pronounced diuretic and anti-diuretic effect. The sesquiterpene components are the major constituents and possibly contributed the diuretic and anti-diuretic activity.
Topics: Alpinia; Animals; Antidiuretic Agents; Diuretics; Male; Plant Extracts; Plant Structures; Rats; Rats, Wistar; Seeds; Sesquiterpenes
PubMed: 28487890
DOI: 10.21010/ajtcam.v13i5.4 -
Kidney360 Jan 2023Volume overload is a common complication encountered in hospitalized patients, and the mainstay of therapy is diuresis. Unfortunately, the diuretic response in some...
BACKGROUND
Volume overload is a common complication encountered in hospitalized patients, and the mainstay of therapy is diuresis. Unfortunately, the diuretic response in some individuals is inadequate despite a typical dose of loop diuretics, a phenomenon called diuretic resistance. An accurate prediction model that predicts diuretic resistance using predosing variables could inform the right diuretic dose for a prospective patient.
METHODS
Two large, deidentified, publicly available, and independent intensive care unit (ICU) databases from the United States were used-the Medical Information Mart for Intensive Care III (MIMIC) and the Philips eICU databases. Loop diuretic resistance was defined as <1400 ml of urine per 40 mg of diuretic dose in 24 hours. Using 24-hour windows throughout admission, commonly accessible variables were obtained and incorporated into the model. Data imputation was performed using a highly accurate machine learning method. Using XGBoost, several models were created using train and test datasets from the eICU database. These were then combined into an ensemble model optimized for increased specificity and then externally validated on the MIMIC database.
RESULTS
The final ensemble model was composed of four separate models, each using 21 commonly available variables. The ensemble model outperformed individual models during validation. Higher serum creatinine, lower systolic blood pressure, lower serum chloride, higher age, and female sex were the most important predictors of diuretic resistance (in that order). The specificity of the model on external validation was 92%, yielding a positive likelihood ratio of 3.46 while maintaining overall discrimination (C-statistic 0.69).
CONCLUSIONS
A diuretic resistance prediction model was created using machine learning and was externally validated in ICU populations. The model is easy to use, would provide actionable information at the bedside, and would be ready for implementation in existing electronic medical records. This study also provides a framework for the development of future machine learning models.
Topics: Humans; Female; Diuretics; Prospective Studies; Sodium Potassium Chloride Symporter Inhibitors; Heart Failure; Machine Learning
PubMed: 36700900
DOI: 10.34067/KID.0005562022 -
Nefrologia 2022Renal sodium and water retention with resulting extracellular volume expansion and redistribution are hallmark features of heart failure syndromes. However, congestion... (Review)
Review
Renal sodium and water retention with resulting extracellular volume expansion and redistribution are hallmark features of heart failure syndromes. However, congestion assessment, monitoring, and treatment represent a real challenge in daily clinical practice. This document reviewed historical and contemporary evidence of available methods for determining volume status and discuss pharmacological aspects and pathophysiological principles that underlie diuretic use.
Topics: Diuretics; Heart Failure; Humans; Sodium; Water; Water-Electrolyte Imbalance
PubMed: 36153911
DOI: 10.1016/j.nefroe.2021.04.007 -
Journal of Veterinary Internal Medicine Nov 2020In human patients, cumulative urine volume (uVol) and urine sodium (uNa) can be predicted using spot urine samples and these quantitative measures help detect low...
BACKGROUND
In human patients, cumulative urine volume (uVol) and urine sodium (uNa) can be predicted using spot urine samples and these quantitative measures help detect low diuretic responsiveness (LDR).
HYPOTHESIS/OBJECTIVES
Formulas using spot urine samples predict cumulative uVol and uNa output after oral administration of furosemide to dogs.
ANIMALS
Eight healthy dogs, 6 dogs with congestive heart failure (CHF).
METHODS
Prospective interventional study. Spot urine samples at 180 and 270 minutes after furosemide (3 mg/kg PO) were used to predict cumulative uVol and uNa output over 7 hours. Differentiation of dogs fulfilling predefined criteria for LDR was examined using receiver operating characteristic (ROC) curves.
RESULTS
Predicted uNa output at 180 minutes (r = 0.763, [95% confidence interval [CI], 0.375-0.923], P = .002) and 270 minutes (r = 0.816, [95% CI, 0.503-0.940], P < .001) was highly correlated to 7-hour uNa output. Predicted uVol at 180 minutes (r = 0.598, [95% CI, 0.098-0.857], P = .02) and 270 minutes (r = 0.791, [95% CI, 0.450-0.931], P < .001) was moderately correlated to 7-hour uVol. Predicted uNa using 180-minute (area under the curve [AUC], 0.933 [95% CI, 0.804-1.000]) and 270-minute (AUC, 0.911 [95% CI, 0.756-1.000]) samples identified dogs with LDR (n = 5) with high accuracy.
CONCLUSIONS AND CLINICAL IMPORTANCE
Urinary Na excretion and uVol are complementary but distinct aspects of diuretic responsiveness in dogs. Quantification of diuretic responsiveness in the clinical setting opens new diagnostic, treatment, and monitoring strategies.
Topics: Administration, Oral; Animals; Diuretics; Dog Diseases; Dogs; Furosemide; Heart Failure; Humans; Prospective Studies
PubMed: 33125814
DOI: 10.1111/jvim.15952 -
Journal of Ethnopharmacology Oct 2021Tagetes erecta L., known as marigold, belongs to the Asteraceae family and is mainly found in South America. Despite reports that T. erecta flowers are used in folk...
ETHNOPHARMACOLOGICAL RELEVANCE
Tagetes erecta L., known as marigold, belongs to the Asteraceae family and is mainly found in South America. Despite reports that T. erecta flowers are used in folk medicine to treat cardiovascular and renal diseases, there is no study regarding its diuretic effect.
AIM
This study aimed to evaluate the chemical composition and the diuretic efficacy of the hydroethanolic extract from T. erecta (HETE) in normotensive (NTR) and hypertensive (SHR) rats.
MATERIAL AND METHODS
The HETE was analyzed by liquid chromatography coupled to diode array detector and mass spectrometry (LC-DAD-MS). Female and male NTR and SHR received the treatment with vehicle, HETE (0.01 mg/kg, 0.1 mg/kg, and 1 mg/kg) or hydrochlorothiazide (HCTZ; 5 mg/kg) orally. The urinary parameters were measured at the end of the 8-h experiment.
RESULTS
From HETE, saccharides and triterpenes were the main annotated compounds, such as erythrodiol and β-amyrin. The urine volume was significantly increased in the groups treated with HETE, in both male and female NTR and SHR rats, compared to the respective vehicle-treated groups. Regarding electrolytes elimination, the treatment with HETE did not reveal significant changes in the urine levels of K or Cl, but it showed a natriuretic and Ca-sparing effects. The HETE beneficial result in reducing Ca excretion was confirmed through the protective effect found in front of the urinary calcium oxalate precipitation and crystallization. The combination with HCTZ, a classic diuretic and saluretic medicine, significantly enhanced HETE-induced diuresis, natriuresis, and the Ca-sparing effect. On the other hand, the K-sparing action was improved in the combination of HETE with amiloride, a standard K-sparing diuretic. In contrast, the combination of HETE with atropine (a non-selective muscarinic receptor antagonist) and indomethacin (an inhibitor of the cyclooxygenase enzyme), promoted an important reduction in urinary volume, but interestingly the natriuretic effect was maintained.
CONCLUSION
This study contributed to the preclinical validation of the diuretic efficacy of T. erecta, highlighting this species as promising for the development of new pharmacological strategies for the management of kidney disorders.
Topics: Animals; Blood Pressure; Diuresis; Diuretics; Female; Flowers; Hypertension; Male; Natriuresis; Phytotherapy; Plant Extracts; Plants, Medicinal; Rats; Rats, Inbred SHR; Rats, Wistar; Tagetes
PubMed: 34229058
DOI: 10.1016/j.jep.2021.114393 -
Hellenic Journal of Cardiology : HJC =... 2023The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim of this study was to analyze different combinations...
BACKGROUND
The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim of this study was to analyze different combinations of diuretics used to resolve congestion in patients admitted for decompensated HF and to define clinical profiles according to these treatments.
METHODS
Single-center study of 1,559 patients admitted for decompensated HF was done between 2016 and 2020. Patients were grouped according to the diuretic combination that led to clinical stabilization and discharge from the hospital: (1) Loop diuretic. (2) Loop diuretic + distal tubule (antialdosterone ± thiazides). (3) Loop diuretic + distal + proximal tubule (acetazolamide ± SGLT2 inhibitor). (4) Loop diuretic + distal tubule + collecting duct (tolvaptan). (5) Loop diuretic + distal + proximal + collecting duct. Based on these diuretic combinations, profiles with clinical, analytical, and echocardiographic differences were established.
RESULTS
There were more previous hospitalizations in groups 4 and 5 (p = 0.001) with a predominance of pulmonary congestion in profiles 1 and 2 and systemic congestion in 3, 4, and 5. Creatinine and CA125 were higher in profiles 4 and 5 (p = 0.01 and p = 0.0001), with no differences in NT-proBNP. Profiles 4 and 5 had a higher proportion of dilatation and depression of right ventricular (p = 0.0001) and left ventricular (p = 0.003) function. Diuretic therapy-defined groups showed difference in clinical characteristics.
CONCLUSIONS
The diuretic treatment used identifies five clinical profiles according to the degree of congestion, renal function, CA125, and right ventricular functionality. These profiles would guide the best diuretic treatment on admission.
Topics: Humans; Diuretics; Sodium Potassium Chloride Symporter Inhibitors; Treatment Outcome; Heart Failure; Phenotype
PubMed: 37068639
DOI: 10.1016/j.hjc.2023.03.009 -
American Journal of Kidney Diseases :... May 1994Despite wide variations in dietary NaCl intake, homeostatic mechanisms ensure that renal NaCl excretion matches intake at steady state. This does not imply, however,... (Review)
Review
Despite wide variations in dietary NaCl intake, homeostatic mechanisms ensure that renal NaCl excretion matches intake at steady state. This does not imply, however, that extracellular fluid volume is maintained within narrow limits. In contrast with blood pressure, which appears to be tightly controlled, extracellular fluid volume varies significantly, even in normal individuals, when dietary NaCl intake changes. Cardiac, liver, or renal disease can perturb the relationship between NaCl intake and extracellular fluid volume and lead to symptomatic edema. All major classes of diuretic drugs in use today were developed between 1950 and 1970. These drugs were developed empirically, without knowledge of specific ion transport pathways, but experimental work during the past 15 years has shown that each major class of diuretic inhibits a specific ion transport protein in the kidney. These transport proteins have been characterized physiologically and the mechanisms by which each diuretic drug inhibits ion transport have been defined. Antibodies directed against these transport proteins have localized ion transport pathways to specific cell types along the nephron. Most recently, isoforms of each class of diuretic-sensitive Na transport pathway have been cloned. Ongoing experimental work is aimed at exploring relationships between families of transporters, determining the structural prerequisites for ion transport, and studying molecular mechanisms of transport regulation. Treatment of edema with diuretics is often straightforward, but can lead to adaptive changes in nephron structure and function. These adaptations can limit the effectiveness of diuretic drugs; maneuvers aimed at blocking these processes can be effective approaches to patients who are resistant to diuretic drugs.
Topics: Animals; Diuretics; Drug Resistance; Edema; Humans; Kidney; Natriuresis
PubMed: 8172204
DOI: 10.1016/s0272-6386(12)70272-x