Acute and Long-Term Effects of Therapy with High-Dose Furosemide in Chronic Hemodialysis Patients

Olden, R. W. van; Meyel, J. J. M. Van; Gerlag, P. G. G.

doi:10.1159/000168471

Cited by 35 publications

(33 citation statements)

References 11 publications

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“…The study was done simultaneously with investigations of the pharmacodynamic actions and adverse effects of high dose furosemide in chronic haemodialysis patients. Those results have already been published [6].…”

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confidence: 69%

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Sensitivity of residual nephrons to high dose furosemide described by diuretic efficiency

Olden¹,

Meyel

Gerlag

1995

Eur J Clin Pharmacol

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Ten haemodialysis (HD) patients with a median residual creatinine clearance (CLCR) of 1.9 ml.min-1 x 1.73 m-2 (range 0.6-5.3) were treated with oral furosemide (F) 2.0 g. Overall-efficiency (O-E, daily sodium excretion/total urinary F) and total-efficiency (delta-E, increase in daily sodium excretion/total urinary F) were measured on the last 24 hours of each interdialysis interval. In addition, O-E was measured during the complete interdialysis interval in 10 HD patients with a median CLCR of 5.6 ml.min-1 x 1.73 m-2 (range 0.7-6.8) treated for 1 year with a fixed oral dose of F between 250-1000 mg (median 625 mg). In the short study the median O-E was 10.6 mmol.mg-1 (range 1.9-22.0) and delta-E 6.2 mmol.mg-1 (range 1.3-11.2). The fractional excretion of sodium FENa was significantly increased from 9.6% (range 4.1-22.9) to 27% (range 14.6-56.2) during F treatment. A positive correlation was found between the basal FENa and delta-E. In the long-term study median O-E was 6.4 mmol.mg-1. O-E and FENa showed no change over time although median RCC decreased from 5.6 to 1.9 ml.min-1 x 1.73 m-2 and median F excretion from 11.8 to 7.5 mg per day. It can be concluded that diuretic efficiency in haemodialysis patients is dependent on FENa and the state of hydration during the interdialysis interval.

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confidence: 69%

“…Previous studies have demonstrated that loop diuretics in high doses are even effective in chronic haemodialysis patients with residual renal function [2][3][4][5][6]. The diuretic response in relation to the excretion of furosemide has not been determined in these patients.…”

mentioning

confidence: 99%

Sensitivity of residual nephrons to high dose furosemide described by diuretic efficiency

Olden¹,

Meyel

Gerlag

1995

Eur J Clin Pharmacol

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“…After several sessions of ultrafiltration dialysis urine output increased. The administration of 250 mg daily of furosemide was then followed by a significant increase in hand, in another study, treatment of patients on RDT with 250-1,000 mg/day of furosemide per os showed a progressive decrease in diuretic response, so that after 12 months salt and urinary excretion was not different from In conditions of severely reduced renal blood flow, a combination of dopamine (1-1.5 g/kg body weight/min) pretreatment values [48]. Thus, considering both the uncertain results and the side effects of the high dosage of and a loop diuretic is assumed to be effective in potentiating the natriuretic effect of the diuretic.…”

Section: Amiloride [Russo Et Al Unpublished Data] (Fig 1) Responsmentioning

confidence: 94%

Diuretics in Renal Failure

Andreucci¹,

Russo²,

Fuiano

et al. 1999

Mineral Electrolyte Metab

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Fluid retention following reduction in the glomerular filtration rate causes extracellular fluid volume expansion that reduces tubular reabsorption by residual nephrons, thereby maintaining the external sodium balance. The price paid for this is salt-dependent hypertension. Thus, loop diuretics are the best treatment for uremic hypertension. Diuretics are also used in chronic renal failure to treat edema due to nephrotic syndrome and congestive heart failure (CHF). In nephrotics, edema is often refractory to diuretics because of low plasma protein, depletion of the intravascular compartment, decrease in the protein-bound fraction of the diuretic in peritubular blood, and increase in tubular fluid. Thus, higher doses are needed. In uremics with CHF the efficacy of diuretics may be hampered because of the reduced renal blood flow. The association of dopamine (1–1.5 µg/kg body weight/min) may overcome this resistance; improvement in cardiac function by dialysis ultrafiltration may also help. Diuretic resistance is sometimes observed; it may be overcome by the following procedures: in CHF by the use of digitalis and/or angiotensin-converting enzyme inhibitors; by substitution of an ineffective loop diuretic for another one; by using larger doses of diuretic; by intravenous infusion rather than bolus therapy, and by a combination of diuretics acting in different segments of the tubule: loop diuretic+thiazide+amiloride. Intravenous infusion of 20% albumin has also been suggested.

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“…The endogenous creatinine clearance continues to decrease after the start of haemodialysis, most markedly during the first 3 months of dialysis [29]. Treatment with high-dose furosemide increased urine output in these patients, but could not prevent the deterioration of the creatinine clearance [30]. A single haemodialysis session decreased the inulin clearance, but had no effect on the clearance of creatinine, because of an opposing effect on tubular secretion [31].…”

Section: Removal Of Uraemic Waste Productsmentioning

confidence: 99%

Advances in Peritoneal Dialysis: Towards Improved Efficacy and Safety

Krediet¹

1998

Blood Purif

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Background: The success of peritoneal dialysis on the short-term is mainly dependent on the prevention of infectious and technical complications. The mid-term results will to a large extent be determined by the ability to remove enough uraemic toxins to prevent uraemic complications and malnutrition. The long-term challenge is the prevention of the development of structural abnormalities of the peritoneum leading to ultrafiltration failure and sometimes peritoneal sclerosis. Methods: A review of the literature on the possibilities to increase the removal of uraemic waste products from the body, and on strategies to detect and prevent deteriorations of the peritoneal membrane during long-term dialysis treatment. Results and Conclusions: Improved efficacy and safety of peritoneal dialysis on the midterm can be achieved by individualization of the dialysis prescription taking residual renal function especially into account. Early start of dialysis might reduce the progression rate of renal function deterioration, but exposes the peritoneum to bio-incompatible dialysis solutions for a longer time. The long-term alterations in the peritoneal membrane are probably mainly caused by the continuous exposure to dialysis fluids, especially glucose, and perhaps the combination of low pH with lactate. The implications of long-term continuous ambulatory peritoneal dialysis using only more biocompatible dialysis fluids are not clear. To improve the efficacy and safety of peritoneal dialysis, careful monitoring of patients and dialysis is mandatory. This should include 24-hour urine collections and 24-hour dialysate collections to calculate the residual glomerular filtration rate and adequacy parameters. A peritoneal membrane function test should be done regularly with 3.86% glucose dialysate, including determinations of dialysate Na⁺ and cancer antigen 125 to detect patients who are at risk for the development of structural abnormalities of the peritoneum.

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Acute and Long-Term Effects of Therapy with High-Dose Furosemide in Chronic Hemodialysis Patients

Cited by 35 publications

References 11 publications

Sensitivity of residual nephrons to high dose furosemide described by diuretic efficiency

Sensitivity of residual nephrons to high dose furosemide described by diuretic efficiency

Diuretics in Renal Failure

Advances in Peritoneal Dialysis: Towards Improved Efficacy and Safety

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