Loop Diuretics Can Cause Clinical Natriuretic Failure: A Prescription for Volume Expansion

Ali, Syed Salman; Olinger, Chad C.; Sobotka, Paul; Dahle, Thom G.; Bunte, Matthew C.; Blake, Donnevan; Boyle, Andrew

doi:10.1111/j.1751-7133.2008.00037.x

Cited by 67 publications

(44 citation statements)

References 20 publications

(46 reference statements)

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“…First, meat contains both creatine and creatinine and thus meat ingestion may augment UCr (19). In addition, ingestion of the constituent amino acids of creatine (glycine and arginine) stimulates creatine synthesis (38,39). Higher cystatin C levels-indicating lower GFR-were associated with lower UCr, an effect that has been previously described (40).…”

Section: Discussionmentioning

confidence: 73%

Urinary Creatinine Excretion, Bioelectrical Impedance Analysis, and Clinical Outcomes in Patients with CKD

Wilson¹,

Xie²,

Anderson³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Previous studies in chronic disease states have demonstrated an association between lower urinary creatinine excretion (UCr) and increased mortality, a finding presumed to reflect the effect of low muscle mass on clinical outcomes. Little is known about the relationship between UCr and other measures of body composition in terms of the ability to predict outcomes of interest.Design, setting, participants, & measurements Using data from the Chronic Renal Insufficiency Cohort (CRIC), the relationship between UCr, fat free mass (FFM) as estimated by bioelectrical impedance analysis, and (in a subpopulation) whole-body dual-energy x-ray absorptiometry assessment of appendicular lean mass were characterized. The associations of UCr and FFM with mortality and ESRD were compared using Cox proportional hazards models.Results A total of 3604 CRIC participants (91% of the full CRIC cohort) with both a baseline UCr and FFM measurement were included; of these, 232 had contemporaneous dual-energy x-ray absorptiometry measurements. Participants were recruited between July 2003 and March 2007. UCr and FFM were modestly correlated (rho=0.50; P,0.001), while FFM and appendicular lean mass were highly correlated (rho=0.91; P,0.001). Higher urinary urea nitrogen, black race, younger age, and lower serum cystatin C level were all significantly associated with higher UCr. Over a median (interquartile range) of 4.2 (3.1-5.0) years of follow-up, 336 (9.3%) participants died and 510 (14.2%) reached ESRD. Lower UCr was associated with death and ESRD even after adjustment for FFM (adjusted hazard ratio for death per 1 SD higher level of UCr, 0.63 [95% confidence interval, 0.56 to 0.72]; adjusted hazard ratio for ESRD per 1 SD higher level of UCr, 0.70 [95% confidence interval, 0.63 to 0.75]).Conclusions Among a cohort of individuals with CKD, lower UCr is associated with death and ESRD independent of FFM as assessed by bioelectrical impedance analysis.

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Section: Discussionmentioning

confidence: 73%

Urinary Creatinine Excretion, Bioelectrical Impedance Analysis, and Clinical Outcomes in Patients with CKD

Wilson¹,

Xie²,

Anderson³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…However, loop diuretics do not protect against hypochloremia because, contrary to sodium, chloride will not be distally reabsorbed. 39,40 On the contrary, thiazides generate less hypotonic urine by inhibiting reabsorption of sodium and chloride from the distal convoluted tubules and, therefore, may aggravate both hyponatremia and hypochloremia. 41,42 Hypothetically, patients with more severe congestion would more often display dilutional hyponatremia, which, as stated above, is associated with worse prognosis.…”

Section: Chloride Pathophysiology and Interplay With Sodiummentioning

confidence: 99%

Serum Chloride and Sodium Interplay in Patients With Acute Myocardial Infarction and Heart Failure With Reduced Ejection Fraction

Ferreira

Girerd

Duarte

et al. 2017

Circ: Heart Failure

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Background— Serum chloride levels were recently found to be independently associated with mortality in heart failure (HF). Methods and Results— We investigated the relationship between serum chloride and clinical outcomes in 7195 subjects with acute myocardial infarction complicated by reduced left ventricular function and HF. The studied outcomes were all-cause mortality, cardiovascular mortality, and hospitalization for HF. Both chloride and sodium had a nonlinear association with the studied outcomes ( P <0.05 for linearity). Patients in the lowest chloride tertile (chloride ≤100) were older, had more comorbidities, and had lower sodium levels ( P <0.05 for all). Serum chloride showed a significant interaction with sodium with regard to all studied outcomes ( P for interaction <0.05 for all). The lowest chloride tertile (≤100 mmol/L) was associated with increased mortality rates in the context of lower sodium (≤138 mmol/L; adjusted hazard ratio [95% confidence interval] for all-cause mortality=1.42 (1.14–1.77); P =0.002), whereas in the context of higher sodium levels (>141 mmol/L), the association with mortality was lost. Spline-transformed chloride and its interaction with sodium did not add significant prognostic information on top of other well-established prognostic variables ( P >0.05 for all outcomes). Conclusions— In post–myocardial infarction with systolic dysfunction and HF, low serum chloride was associated with mortality (but not hospitalization for HF) in the setting of lower sodium. Overall, chloride and its interaction with sodium did not add clinically relevant prognostic information on top of other well-established prognostic variables. Taken together, these data support an integrated and critical consideration of chloride and sodium interplay.

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“…These results support the hypothesis that removal of isotonic fluid by ultrafiltration rather than hypotonic urine by intravenous diuretics may explain the improved clinical benefits of ultrafiltration. 40 However, ultrafiltration increases the complexity of care.…”

Section: Treatmentmentioning

confidence: 99%

“…39,40 In patients unable to tolerate these agents, hydralazine and nitrates may be an option. Left ventricular assist devices can be used as a bridge to transplantation or cardiac surgery.…”

Section: Crs Typementioning

confidence: 99%

Cardiorenal syndrome

Omar

Zedan

2013

SW Resp Crit Care Chron

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The case below illustrates a common clinical problem in patients with both acute and chronic cardiac diseases, namely the development of renal dysfunction. This clinical presentation has been called a cardiorenal syndrome; this construct should lead to a better understanding of the interactions between cardiac and renal disorders and the effect of this interaction on management and outcomes. We have reviewed this topic by discussing the definitions, prevalence, pathophysiology, and treatment of cardiorenal syndromes. cAseA 68-year-old man with ischemic heart disease, type 2 diabetes mellitus, hypertension, and hyperlipidemia had been admitted with a ST segment elevation myocardial infarction three months previously. At this follow up visit he presented with gradually increasing shortness of breath, generalized swelling, and some abdominal distension. The patient was admitted to the coronary care unit. On admission, his blood pressure was 110/62 mmHg, and he had bibasilar rales and bipedal pitting edema. The patient had oliguria with a urine output of 10 ml/hour during the first day. The patient's baseline creatinine was 1.2 mg/dl; on admission his creatinine was 2.6 mg/dl and his blood

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Loop Diuretics Can Cause Clinical Natriuretic Failure: A Prescription for Volume Expansion

Cited by 67 publications

References 20 publications

Urinary Creatinine Excretion, Bioelectrical Impedance Analysis, and Clinical Outcomes in Patients with CKD

Urinary Creatinine Excretion, Bioelectrical Impedance Analysis, and Clinical Outcomes in Patients with CKD

Serum Chloride and Sodium Interplay in Patients With Acute Myocardial Infarction and Heart Failure With Reduced Ejection Fraction

Cardiorenal syndrome

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