Effect of the combination of bumetanide plus chlorthalidone on hypertension and volume overload in patients with chronic kidney disease stage 4–5 KDIGO without renal replacement therapy: a double-blind randomized HEBE-CKD trial

Solis-Jimenez, Fabio; Perez-Navarro, Lucia Monserrat; Cabrera-Barron, Ricardo; Chida-Romero, Jesus Antonio; Martín-Alemañy, Geovana; Dehesa-López, Edgar; Madero, Magdalena; Valdez-Ortiz, Rafael

doi:10.1186/s12882-022-02930-4

Cited by 3 publications

(3 citation statements)

References 48 publications

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“…When primary focal segmental glomerulosclerosis develops further, it can lead to renal insufficiency and hypertension. The mechanisms of primary focal segmental glomerulosclerosis causing hypertension mainly involve: (I) the activation of the reninangiotensin system leads to the increase of renin-angiotensin secretion, resulting in hypertension (11)(12)(13); and (II) water and sodium retention due to renal insufficiency causes excessive blood volume, which leads to hypertension (14)(15)(16). Malignant hypertension can also promote glomerular filtration rate decline, atrophy of renal tubules, and renal interstitial fibrosis, leading to the development of end-stage renal disease and eventually forming a vicious circle (17).…”

Section: Discussionmentioning

confidence: 99%

Effect of hypertension on the long-term prognosis of children with primary focal segmental glomerulosclerosis-a retrospective cohort study

Huang¹,

Peng²

2023

Transl Pediatr

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Background: Primary focal segmental glomerulosclerosis is a common clinicopathologic syndrome. More than 50% of the patients may have hypertension, which can further deteriorate the renal function of patients.However, the impact of hypertension on the development of end-stage renal disease in children with primary focal segmental glomerulosclerosis is still unclear. The end-stage renal disease greatly increases medical costs and mortality. Studying the related factors of end-stage renal disease is helpful to prevent and treat end-stage renal disease. This study aimed to explore the impact of hypertension on the long-term prognosis of children with primary focal segmental glomerulosclerosis. Methods:The data of 118 children with primary focal segmental glomerulosclerosis admitted to the Nursing Department of West China Second Hospital from January 2012 to January 2017 were retrospectively collected. The children were divided into a hypertension group (n=48) and a control group (n=70) according to whether they had hypertension. The children were followed up (by clinic visit and telephone interviews) for 5 years to compare the differences in the incidence of end-stage renal disease between the two groups.Results: Compared with the control group, the proportion of patients with severe renal tubulointerstitial damage in the hypertension group was significantly higher (18.75% vs. 5.71%, P=0.026). Moreover, the incidence of end-stage renal disease was markedly higher (33.33% vs. 5.71%, P<0.001). Both systolic and diastolic blood pressure had a certain value in predicting the development of end-stage renal disease in children with primary focal segmental glomerulosclerosis (P<0.001 and P=0.025, respectively), and the predictive value of systolic blood pressure was relatively higher. Multivariate logistic regression analysis showed that hypertension was risk factors for end-stage renal disease in children with primary focal segmental glomerulosclerosis (P=0.009, relative risk: 17.022, 95% CI: 2.045-141.723).Conclusions: Hypertension was a risk factor for poor long-term prognosis in children with primary focal segmental glomerulosclerosis. For primary focal segmental glomerulosclerosis children with hypertension, blood pressure should be actively controlled to prevent the development of end-stage renal disease.Moreover, due to the high incidence of end-stage renal disease, we should monitor the end-stage renal disease during follow-up.

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Section: Discussionmentioning

confidence: 99%

Effect of hypertension on the long-term prognosis of children with primary focal segmental glomerulosclerosis-a retrospective cohort study

Huang¹,

Peng²

2023

Transl Pediatr

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“…Data from patients with heart failure showed that diuretic combinations such as loop diuretic with a thiazide diuretic or with acetazolamide have proven their efficiency. Also, combined diuretics seem to be effective in patients with advanced chronic kidney disease or even nephrotic edema, but on the latter, there is only one RCT published so far [18][19][20][21]. Therefore, the aim of our study was to assess the non-inferiority and safety profile of the oral combination of furosemide/hydrochlorothiazide/amiloride compared to i.v.…”

Section: Introductionmentioning

confidence: 99%

Oral Furosemide and Hydrochlorothiazide/Amiloride versus Intravenous Furosemide for the Treatment of Resistant Nephrotic Syndrome

Frățilă,

Sorohan,

Achim

et al. 2023

JCM

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Background: Data on diuretic treatment in nephrotic syndrome (NS) are scarce. Our goal was to assess the non-inferiority of the combined oral diuretics (furosemide/hydrochlorothiazide/amiloride) compared to intravenous (i.v.) furosemide in patients with NS and resistant edema. Methods: We conducted a prospective randomized trial on 22 patients with resistant nephrotic edema (RNE), defined as hypervolemia and a FENa < 0.2%. Based on a computer-generated 1:1 randomization, we assigned patients to receive either intravenous furosemide (40 mg bolus and then continuous administration of 5 mg/h) or oral furosemide (40 mg/day) and hydrochlorothiazide/amiloride (50/5 mg/day) for a period of 5 days. Clinical and laboratory measurements were performed daily. Hydration status was assessed by bioimpedance on day 1 and at the end of day 5 after treatment initiation. The primary endpoint was weight change from baseline to day 5. Secondary endpoints were hydration status change measured by bioimpedance and safety outcomes (low blood pressure, severe electrolyte disturbances, acute kidney injury and worsening hypervolemia). Results: Primary endpoint analysis showed that after 5 days of treatment, there was a significant difference in weight change from baseline between groups [adjusted mean difference: −3.33 kg (95% CI: −6.34 to −0.31), p = 0.03], with a higher mean weight change in the oral diuretic treatment group [−7.10 kg (95% CI: −18.30 to −4.30) vs. −4.55 kg (95%CI: −6.73 to −2.36)]. Secondary endpoint analysis showed that there was no significant difference between groups regarding hydration status change [adjusted mean difference: −0.05 L (95% CI: −2.6 to 2.6), p = 0.96], with a mean hydration status change in the oral diuretic treatment group of −4.71 L (95% CI: −6.87 to −2.54) and −3.91 L (95% CI: −5.69 to −2.13) in the i.v. diuretic treatment group. We observed a significant decrease in adjusted mean serum sodium of −2.15 mmol/L [(95% CI: −4.25 to −0.05), p = 0.04]), favored by the combined oral diuretic treatment [−2.70 mmol/L (95% CI: −4.89 to −0.50) vs. −0.10 mmol/L (95%CI: −1.30 to 1.10)]. No statistically significant difference was observed between the two groups in terms of adverse events. Conclusions: A combination of oral diuretics based on furosemide, amiloride and hydrochlorothiazide is non-inferior to i.v. furosemide in weight control of patients with RNE and a similar safety profile.

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“…In the 2021 KDIGO guidelines, the selection of antihypertensive drugs is recommended to start with monotherapy for those over 75 years of age, and to sequentially combine ACEI or ARB with a thiazide-based diuretic (loop diuretics for advanced CKD) or CCB 2) . Considering the risk of thiazide induced hyponatremia, chlorothalidone had good clinical results for lowering blood pressure in advanced CKD patients 33) , however, the enrolled mean age was below 60 years old (HEBE-CKD trial) even if it was RCT study 34) . In other studies, chlorthalidone was associated with a greater incidence of hypokalemia and hyponatremia of equal dose compared with thiazide, therefore we consider to follow up the electrolyte for a while 35 36) .…”

Section: Introductionmentioning

confidence: 99%

Blood Pressure Control in Elderly Chronic Kidney Disease Patients

Yang

2022

Electrolyte Blood Press

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In elderly chronic kidney disease (CKD) patients, isolated systolic hypertension is common, the rate of renal function decline is slow, and there is a high possibility of physical damage due to side effects such as drug use-related orthostatic hypotension. Therefore, there are still many questions about whether lowering blood pressure in elderly patients will actually improve prognosis. Since many blood pressure-related clinical studies exclude advanced CKD and the elderly, it is particularly difficult to define target blood pressure in these populations. A randomized controlled trial is needed to establish optimal blood pressure targets and treatment strategies in elderly patients with CKD. This review seeks to summarize the guidelines available at this time.

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Effect of the combination of bumetanide plus chlorthalidone on hypertension and volume overload in patients with chronic kidney disease stage 4–5 KDIGO without renal replacement therapy: a double-blind randomized HEBE-CKD trial

Cited by 3 publications

References 48 publications

Effect of hypertension on the long-term prognosis of children with primary focal segmental glomerulosclerosis-a retrospective cohort study

Effect of hypertension on the long-term prognosis of children with primary focal segmental glomerulosclerosis-a retrospective cohort study

Oral Furosemide and Hydrochlorothiazide/Amiloride versus Intravenous Furosemide for the Treatment of Resistant Nephrotic Syndrome

Blood Pressure Control in Elderly Chronic Kidney Disease Patients

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