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

Abstract

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.

Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis

“…In contrast to what had been observed in other studies [11,21], which acutely encountered an increase in FENa after furosemide use, our study has not encountered a statistically significant difference between FENa in the DG and NDG (p = 0.91, Table 3). In contrast to studies acutely using high doses of diuretics for short periods of time, the patients in our study had been using diuretics chronically, with small doses of furosemide for at least 5 months, and had normal sodium ingestion.…”

“…Our study showed that GFR was similar in the DG and NDG (p = 0.07, Table 3); however, the mean values for GFR could have been similar due to the reduced number of patients in each group. As per van Olden et al [21], our data has shown this correlation that patients with higher UVNa present higher GFR (p = 0.0004, r = 0.73, Fig. 3).…”

“…In another study, van Olden et al [21] found that UV increased an average of 560 ml after administration of 1000 mg/day of furosemide. The diuretic response can be quantified in many ways, including UV, total UVNa and FENa.…”

Clinical Consequences of the Biphasic Elimination Kinetics for the Diuretic Effect of Furosemide and its Acyl Glucuronide in Humans

“…In clinical practice, furosemide is administered repetitively to shift the pathological homoeostasis (water, sodium balance; oedematous state associated with congestive heart failure) of the body in cardiac failure or decompensatio cordis. Repetitive intravenous administration of furosemide results in a gradual decrease in urine and sodium output (Kaissling et al 1985;Gerlag & VanMeyel 1988;Brater 1991;Lahav et al 1992;VanOlden et al 1992VanOlden et al , 1995. The diuretic as well as the post-diuretic effect (rebound effect) add to the overall effect of dehydration upon repetitive dosing (Copeland et al 1983;VanMeyel et al 1994;Kang et al 1995).…”

“…These high dosages do increase the residual diuresis in the short term. During long-term treatment this effect wears off (Gerlag & VanMeyel 1988;Brater 1991;VanOlden et al 1992VanOlden et al , 1995. Furosemide has sig-ni®cant renal and extrarenal haemodynamic effects in congestive heart failure (Dikshit et al 1973;Brater et al 1980).…”