The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial
Abstract Aim The main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion. It is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF). Methods In a pilot double-blind r...
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-021-02637-y |
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| author | Jonathan S. Chávez-Iñiguez Miguel Ibarra-Estrada Sergio Sánchez-Villaseca Gregorio Romero-González Jorge J. Font-Yañez Andrés De la Torre-Quiroga Andrés Aranda-G de Quevedo Alexia Romero-Muñóz Pablo Maggiani-Aguilera Gael Chávez-Alonso Juan Gómez-Fregoso Guillermo García-García |
| author_facet | Jonathan S. Chávez-Iñiguez Miguel Ibarra-Estrada Sergio Sánchez-Villaseca Gregorio Romero-González Jorge J. Font-Yañez Andrés De la Torre-Quiroga Andrés Aranda-G de Quevedo Alexia Romero-Muñóz Pablo Maggiani-Aguilera Gael Chávez-Alonso Juan Gómez-Fregoso Guillermo García-García |
| author_sort | Jonathan S. Chávez-Iñiguez |
| collection | DOAJ |
| description | Abstract Aim The main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion. It is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF). Methods In a pilot double-blind randomized controlled trial of CRS1 patients were allocated in a 1:1 fashion to SF or CD. The SF group received a continuous infusion of furosemide 100 mg during the first day, with daily incremental doses to 200 mg, 300 mg and 400 mg. The CD group received a combination of diuretics, including 4 consecutive days of oral chlorthalidone 50 mg, spironolactone 50 mg and infusion of furosemide 100 mg. The objectives were to assess renal function recovery and variables associated with vascular decongestion. Results From July 2017 to February 2020, 80 patients were randomized, 40 to the SF and 40 to the CD group. Groups were similar at baseline and had several very high-risk features. Their mean age was 59 ± 14.5 years, there were 37 men (46.2%). The primary endpoint occurred in 20% of the SF group and 15.2% of the DC group (p = 0.49). All secondary and exploratory endpoints were similar between groups. Adverse events occurred frequently (85%) with no differences between groups (p = 0.53). Conclusion In patients with CRS1 and a high risk of resistance to diuretics, the use of CD compared to SF offers the same results in renal recovery, diuresis, vascular decongestion and adverse events, and it can be considered an alternative treatment. ClinicalTrials.gov with number NCT04393493 on 19/05/2020 retrospectively registered. |
| first_indexed | 2024-04-11T20:45:35Z |
| format | Article |
| id | doaj.art-c5368bb92c1e4f769f8f27388aed91ee |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-11T20:45:35Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-c5368bb92c1e4f769f8f27388aed91ee2022-12-22T04:04:04ZengBMCBMC Nephrology1471-23692022-01-012311910.1186/s12882-021-02637-yThe Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized TrialJonathan S. Chávez-Iñiguez0Miguel Ibarra-Estrada1Sergio Sánchez-Villaseca2Gregorio Romero-González3Jorge J. Font-Yañez4Andrés De la Torre-Quiroga5Andrés Aranda-G de Quevedo6Alexia Romero-Muñóz7Pablo Maggiani-Aguilera8Gael Chávez-Alonso9Juan Gómez-Fregoso10Guillermo García-García11Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeUnidad de Terapia Intensiva, Hospital Civil de Guadalajara Fray Antonio AlcaldeServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeDepartamento de Nefrología, Clínica Universidad de NavarraServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeUniversidad de Guadalajara, Centro Universitario de Ciencias de la Salud CUCSServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeServicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio AlcaldeAbstract Aim The main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion. It is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF). Methods In a pilot double-blind randomized controlled trial of CRS1 patients were allocated in a 1:1 fashion to SF or CD. The SF group received a continuous infusion of furosemide 100 mg during the first day, with daily incremental doses to 200 mg, 300 mg and 400 mg. The CD group received a combination of diuretics, including 4 consecutive days of oral chlorthalidone 50 mg, spironolactone 50 mg and infusion of furosemide 100 mg. The objectives were to assess renal function recovery and variables associated with vascular decongestion. Results From July 2017 to February 2020, 80 patients were randomized, 40 to the SF and 40 to the CD group. Groups were similar at baseline and had several very high-risk features. Their mean age was 59 ± 14.5 years, there were 37 men (46.2%). The primary endpoint occurred in 20% of the SF group and 15.2% of the DC group (p = 0.49). All secondary and exploratory endpoints were similar between groups. Adverse events occurred frequently (85%) with no differences between groups (p = 0.53). Conclusion In patients with CRS1 and a high risk of resistance to diuretics, the use of CD compared to SF offers the same results in renal recovery, diuresis, vascular decongestion and adverse events, and it can be considered an alternative treatment. ClinicalTrials.gov with number NCT04393493 on 19/05/2020 retrospectively registered.https://doi.org/10.1186/s12882-021-02637-yAcute kidney injuryCardio-renal syndromeCongestive heart failureDiureticsDiuresis |
| spellingShingle | Jonathan S. Chávez-Iñiguez Miguel Ibarra-Estrada Sergio Sánchez-Villaseca Gregorio Romero-González Jorge J. Font-Yañez Andrés De la Torre-Quiroga Andrés Aranda-G de Quevedo Alexia Romero-Muñóz Pablo Maggiani-Aguilera Gael Chávez-Alonso Juan Gómez-Fregoso Guillermo García-García The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial BMC Nephrology Acute kidney injury Cardio-renal syndrome Congestive heart failure Diuretics Diuresis |
| title | The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial |
| title_full | The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial |
| title_fullStr | The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial |
| title_full_unstemmed | The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial |
| title_short | The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial |
| title_sort | effect in renal function and vascular decongestion in type 1 cardiorenal syndrome treated with two strategies of diuretics a pilot randomized trial |
| topic | Acute kidney injury Cardio-renal syndrome Congestive heart failure Diuretics Diuresis |
| url | https://doi.org/10.1186/s12882-021-02637-y |
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