The saluretic effect of the thiazide diuretic bemetizide in relation to the glomerular filtration rate

Knauf, H.; Cawello, Willi; Schmidt, Günther; Mutschler, E.

doi:10.1007/bf00195908

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…The same findings were reported earlier for other thiazides such as xipamide (KNAUF and MUTSCHLER 1984) and bemetizide (KNAUF et al 1994) studied in advanced renal failure. Obviously, nephron adaptation in renal failure maintains the ion transport characteristics of the early distal tubule, the site of action of thiazides.…”

Section: Responses In Renal Failuresupporting

confidence: 88%

“…These diseases appear to have as a hallmark of their clinical syndrome disturbances of volume regulation. The effectiveness of acetazolamide co administered with thiazides corroborates increased proximal-tubular Na+ reabsorption as the major alteration in such disease states (KNAUF and MUTSCHLER 1994). The kidney responds to vascular underfilling by proximal tubular hyperreabsorption followed by a reduced Na+ load delivered to the loop of Henle and the distal tubule, the sites of diuretic action.…”

Section: Coadministration With Other Diuretics In Edematous Statementioning

confidence: 71%

“…Loop diuretics again are the drugs of choice here (HEIDLAND et al 1972). However, more recent studies indicate that thiazides are effective, too, at fairly low GFR values albeit much less so than loop diuretics (KNAUF et al 1994;KNAUF and MUTSCHLER 1993b). For thiazides this has previously been refuted.…”

Section: Chronic Renal Failurementioning

confidence: 99%

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Diuretics

1995

Handbook of Experimental Pharmacology

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Section: Responses In Renal Failuresupporting

confidence: 88%

Section: Coadministration With Other Diuretics In Edematous Statementioning

confidence: 71%

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Diuretics

1995

Handbook of Experimental Pharmacology

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“…Conversely, thiazides such as hydrochlorothiazide (HCTZ) are rarely used in patients with CKD because they can increase sodium fractional excretion by only 5% to 10% 7 . Some authors believe thiazides lose their effectiveness as soon as the GFR ranges below 30 mL/min, 8,9 and this notion has been widely accepted, but we and other authors have demonstrated in short‐term and experimental studies that the natriuretic effect of thiazides is preserved in patients with low GFR 10–14 …”

mentioning

confidence: 96%

A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease

Dussol

Moussi-Francès

Morange

et al. 2011

J of Clinical Hypertension

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Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double‐blind, cross‐over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long‐acting furosemide (60 mg) and hydrochlorothiazide (25 mg) for 3 months and then both diuretics for 3 months. Sodium and chloride fractional excretions were measured after 3 months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the two diuretics increased the fractional excretions of sodium and chloride from 3.4±1.8 to 4.9±2.8 and from 3.8±2.0 to 6.0±3.1, respectively (P<.05). Furosemide and hydrochlorothiazide decreased mean blood pressure by the same extent. The association of the two diuretics was more efficient on blood pressure. There were no differences between furosemide and hydrochlorothiazide with respect to natriuresis and blood pressure control in patients with hypertension and chronic kidney disease.

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“…Correlation between the excretion of sodium and potassium induced by oral hydrochlorothiazide, 25 mg, and the glomerular filtration rate. vanced renal failure, the maximal fractional excretion of sodium achieved by loop diuret ics was 25% [4] and that with the addition of a thiazide [3] was 15%. The FENa could be dou bled by the addition of amiloride [4,5].…”

Section: Qualitative Differences Of Responses To Diuretics In Renal Fmentioning

confidence: 99%

Functional State of the Nephron and Diuretic Dose-Response - Rationale for Low-Dose Combination Therapy

Knauf

Mutschler²

1994

Cardiology

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The functions of the different nephron segments follow changes in the effective arterial blood volume and the extracellular fluid volume. In syndromes with reduced effective arterial blood volume, for example congestive heart failure, decompensated hepatic cirrhosis and nephrotic syndrome, hyperreabsorption of sodium in the proximal tubule reduces the sodium load in the more distal segments of the nephron. As this is a major site of sodium excretion, reduction in the response to a diuretic may be predicted by a reduced fractional excretion of sodium ( < 0.2%). Such diuretic resistance may be overcome with acetazolamide, which increases delivery of sodium to the distal tubule. In syndromes with increased extracellular fluid volume, such as chronic renal failure, distal tubular rejection of sodium leads to a progressive increase in its fractional excretion as the glomerular filtration rate is reduced. The remaining intact nephrons exhibit a relatively increased response to diuretics. The efficacy of loop diuretics in renal failure can be optimized by combination with thiazides. The latter prevent early distal tubular hyperreabsorption following diuretic-induced blockade of sodium transport in the loop of Henle. For these reasons, low-dose combinations of different diuretics induce ‘segmental nephron blockade’ and are, therefore, potentially more clinically effective and safer than high doses of single compounds.

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The saluretic effect of the thiazide diuretic bemetizide in relation to the glomerular filtration rate

Cited by 13 publications

References 24 publications

Diuretics

Diuretics

A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease

Functional State of the Nephron and Diuretic Dose-Response - Rationale for Low-Dose Combination Therapy

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