The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial

BMC Nephrology

Gregorio Romero-González¹  Andrés Aranda-G de Quevedo²  Jorge J. Font-Yañez²  Sergio Sánchez-Villaseca²  Alexia Romero-Muñóz²  Guillermo García-García²  Andrés De la Torre-Quiroga²  Jonathan S. Chávez-Iñiguez²  Pablo Maggiani-Aguilera²  Juan Gómez-Fregoso²  Miguel Ibarra-Estrada³  Gael Chávez-Alonso⁴ 

[1]Departamento de Nefrología, Clínica Universidad de Navarra

[2]Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde

[3]Unidad de Terapia Intensiva, Hospital Civil de Guadalajara Fray Antonio Alcalde

[4]Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud CUCS

关键词: Acute kidney injury;    Cardio-renal syndrome;    Congestive heart failure;    Diuretics;    Diuresis;   

DOI  :  10.1186/s12882-021-02637-y

来源: DOAJ

【 摘 要 】

Abstract Aim The main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion. It is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF). Methods In a pilot double-blind randomized controlled trial of CRS1 patients were allocated in a 1:1 fashion to SF or CD. The SF group received a continuous infusion of furosemide 100 mg during the first day, with daily incremental doses to 200 mg, 300 mg and 400 mg. The CD group received a combination of diuretics, including 4 consecutive days of oral chlorthalidone 50 mg, spironolactone 50 mg and infusion of furosemide 100 mg. The objectives were to assess renal function recovery and variables associated with vascular decongestion. Results From July 2017 to February 2020, 80 patients were randomized, 40 to the SF and 40 to the CD group. Groups were similar at baseline and had several very high-risk features. Their mean age was 59 ± 14.5 years, there were 37 men (46.2%). The primary endpoint occurred in 20% of the SF group and 15.2% of the DC group (p = 0.49). All secondary and exploratory endpoints were similar between groups. Adverse events occurred frequently (85%) with no differences between groups (p = 0.53). Conclusion In patients with CRS1 and a high risk of resistance to diuretics, the use of CD compared to SF offers the same results in renal recovery, diuresis, vascular decongestion and adverse events, and it can be considered an alternative treatment. ClinicalTrials.gov with number NCT04393493 on 19/05/2020 retrospectively registered.

【 授权许可】

Unknown