scholarly journals A Novel Association Between Loop Diuretic Therapy and Repigmentation in Two Patients With Vitiligo

Cureus ◽  
2021 ◽  
Author(s):  
Mary Arndt ◽  
Rachel Sennett ◽  
Amanda Marsch
Keyword(s):  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Novel Association

Diuretic response and effects of diuretic omission in ambulatory heart failure patients on chronic low‐dose loop diuretic therapy

2021 ◽  
Author(s):  
Jeroen Dauw ◽  
Pieter Martens ◽  
Gregorio Tersalvi ◽  
Joren Schouteden ◽  
Sébastien Deferm ◽  
...  
Keyword(s):  
Heart Failure ◽  
Low Dose ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Heart Failure Patients ◽  
Diuretic Response

Abstract 187: Loop Diuretic Therapy in Acute Decompensated Heart Failure among Premier Hospitals

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Behnood Bikdeli ◽  
Kelly Strait ◽  
Kumar Dharmarajan ◽  
Chohreh Partovian ◽  
Nancy Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Loop Diuretics ◽  
High Rate ◽  
Average Daily Dose ◽  
Duration Of Therapy ◽  
Daily Dose ◽  
Hospital Use

Background: Although loop diuretics are frequently used for patients with heart failure (HF), little is known about the variation in patterns of diuretic therapy in US hospitals. We sought to describe such treatment patterns among a diverse group of hospitals. Methods: We studied HF hospitalizations occurring during 2009-10 in Premier Inc. hospitals participating in a collaborative project to pool administrative and charge data, which includes information about drug types, average daily dose, and duration of therapy. We excluded hospitals with less than 25 HF hospitalizations. For ease of comparison, all diuretic doses were converted to bioequivalent doses of intravenous (IV) furosemide: 40mg IV furosemide ∼ 80mg oral furosemide ∼ 20mg (oral or IV) torsemide ∼ 1mg (oral or IV) bumetanide. Summary statistics were calculated. Results: Among 366 studied hospitals (264,675 HF hospitalizations), use of any loop diuretic had an interquartile range (IQR) from 92% to 96% (median: 94%). At the hospital level, the average daily dose IQR varied from 45mg to 64 mg (median: 55 mg) and the median duration of therapy was 4 days (IQR: 4 to 4; median: 4), as was the median length of stay. The IQR for use of furosemide varied from 89% to 94% (median: 92%), and its median average daily dose had an IQR from 40mg to 60 mg (median: 53 mg). Hospital use of bumetanide had an IQR from 2% to 11%, and hospital use of torsemide had an IQR from 0% to 4% (medians of 5% and 1%, respectively). The variation in median average daily dose for bumetanide and torsemide was greater than for furosemide (bumetanide IQR: 79mg to 127 mg, with median of 89 mg; torsemide IQR: 53mg to 120 mg, with median of 80 mg). Use of IV diuretics on the last day before home discharge had an IQR from 16% to 33% (median: 24%) across hospitals. Conclusion: US hospitals administer loop diuretics, particularly furosemide, to the vast majority of HF inpatients. The duration and daily dosage of therapy was similar across most hospitals. In contrast, a minority of hospitals used bumetanide and torsemide for several patients. The daily dosage of these agents showed more marked variation. We observed a high rate of intravenous diuretic use on the last day of hospitalization, with considerable variation across hospitals.

scholarly journals ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

2019 ◽  
pp. 61-63
Author(s):  
PRUDENCE A RODRIGUES ◽  
SOUMYA GK ◽  
NADIA GRACE BUNSHAW ◽  
SARANYA N ◽  
SUJITH K ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Injury ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Loop Diuretics ◽  
Contributing Factors ◽  
The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

scholarly journals An exploratory analysis of the competing effects of aggressive decongestion and high-dose loop diuretic therapy in the DOSE trial

2017 ◽  
Vol 241 ◽  
pp. 277-282 ◽  
Author(s):  
Jennifer S. Hanberg ◽  
W.H. Wilson Tang ◽  
F. Perry Wilson ◽  
Steven G. Coca ◽  
Tariq Ahmad ◽  
...  
Keyword(s):  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Exploratory Analysis ◽  
High Dose ◽  
Dose Trial

Intravenous Chlorothiazide Versus Enteral Metolazone to Augment Loop Diuretic Therapy in the Intensive Care Unit

2016 ◽  
Vol 51 (4) ◽  
pp. 286-292 ◽  
Author(s):  
Christopher J. Michaud ◽  
Kendall C. Mintus
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Loop Diuretic ◽  
Medical Center ◽  
Diuretic Therapy ◽  
Rapid Change ◽  
Icu Length Of Stay ◽  
Potassium Replacement ◽  
Critically Ill Adults ◽  
Ill Adults

Background: In cases of loop diuretic resistance in the intensive care unit (ICU), recommendations for a specific second-line thiazide agent are lacking. Objective: To compare the effects of intravenous chlorothiazide (CTZ) and enteral metolazone (MET) on urine output (UOP) when added to furosemide monotherapy therapy in critically ill adults. Methods: This was a retrospective cohort study conducted in the medical, surgical, and cardiothoracic ICUs of a quaternary medical center. The primary outcome was change in UOP induced by the study interventions compared with furosemide alone. Secondary outcomes included onset of diuresis, eventual need for hemodialysis, and incidence of adverse events. Results: A total of 122 patients (58 in CTZ, 64 in MET) were included. When added to furosemide monotherapy, CTZ induced a greater change in UOP at 24 hours compared with MET (2405 vs 1646 mL, respectively; P = 0.01). CTZ also caused a more rapid dieresis: 1463 mL total UOP in the first 6 hours compared with 796 mL in the MET group ( P < 0.01). There were no differences found regarding ICU length of stay, need for renal replacement therapy, or survival to discharge. The CTZ arm required more potassium supplementation to maintain normokalemia (median 100 vs 57 mEq in MET; P = 0.02) and carried a higher cost (mean $97 vs $8, P < 0.01). Conclusion: Both CTZ and MET induced significant increases in UOP. CTZ induced a greater and more rapid change and was associated with higher cost and greater need for potassium replacement. Randomized controlled trials are needed to establish whether a preferable thiazide diuretic exists in this setting.

P765One-year mortality risk after intensification of outpatient diuretics

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Madelaire ◽  
F Gustafsson ◽  
S L Kristensen ◽  
L W Stevenson ◽  
L Koeber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Risk ◽  
Angiotensin Receptor Blocker ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Outpatient Setting ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
One Year

Abstract Background Mortality is increased following a hospitalization for heart failure (HF). It is not clear whether outpatient intensification of diuretic confers the same increased risk in the general population with heart failure Purpose This study sought to assess 1-year mortality risk after worsening HF, defined either as hospitalization due to HF or as intensified diuretic therapy in an outpatient setting, in a complete nationwide cohort of patients with HF on angiotensin converting enzyme inhibitors/ angiotensin receptor blocker and beta blockers. Methods From nationwide administrative registers, we identified all patients in Denmark diagnosed with HF in 2001–2016 and prescribed angiotensin converting enzyme inhibitor/ angiotensin receptor blocker and beta blocker within 120 days. During follow-up we defined worsening HF by the following events: Inpatient worsening (HF readmission) and outpatient worsening (intensified diuretic therapy, defined as the first event of new addition or doubled dosage of loop diuretic therapy or new onset addition of thiazide to loop diuretic therapy). Patients with a worsening event were risk set matched to two HF controls each at time of the event – based on age, sex and calendar year. One-year mortality risk was estimated with Kaplan-Meier and multivariable Cox regression models. Results We included 74,990 patients, median age 71 years (interquartile range: 62–79), 36% women. During five years of follow up, 8,727 patients had an inpatient worsening event, and 12,290 had an outpatient worsening event as first event. Absolute risk of 1-year mortality was 22.6% (95%-confidence interval (95%-CI): 21.7%-23.5%) after inpatient worsening, 18.0% (95%-CI: 17.3%-18.7%) after outpatient worsening compared to 9.8% (95%-CI: 9.5%-10.1%) for the matched controls. In a multivariable Cox model adjusted ischemic heart disease, atrial fibrillation, chronic obstructive pulmonary disease and diabetes, the hazard ratio for mortality among patients experiencing inpatient worsening was 2.46 (95%-CI: 2.33–2.60) and for outpatient worsening was 1.87 (95%-CI: 1.77–1.97), compared with the matched HF controls as reference (figure 1). Among patients who had an outpatient worsening as first event, 1,245 (10.1%) had a subsequent HF readmission within one year. Conclusion In a nationwide cohort of patients with HF, outpatient worsening defined by a diuretic intensification was associated with almost 2-fold risk of mortality during the next year. Although HF hospitalization is associated with a higher risk, the need to intensify diuretics in the outpatient setting is a signal to review and intensify efforts to improve HF outcomes. Acknowledgement/Funding The Danish Heart Foundation, (grant number 17-R116-A7610-22048)

DETRIMENTAL EFFECT OF LOOP DIURETIC THERAPY IN A GERIATRIC POPULATION

2008 ◽  
Vol 19 ◽  
pp. S40
Author(s):  
Franco Carmassi ◽  
Ferdinando de Negri ◽  
Antonio De Giorgi ◽  
Ferdinando Pentimone
Keyword(s):  
Detrimental Effect ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Geriatric Population

Torasemide in hypertension and heart failure: re-inventing loop diuretic therapy?

2021 ◽  
Vol 27 ◽  
Author(s):  
Athanasios Manolis ◽  
Manolis Kallistratos ◽  
Michael Doumas
Keyword(s):  
Heart Failure ◽  
Arterial Hypertension ◽  
European Society ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Loop Diuretics ◽  
Hypertensive Patients ◽  
Esc Guidelines ◽  
European Society Of Cardiology ◽  
First Time

: In heart failure (HF) patients, current European Society of Cardiology (ESC) guidelines recommends the use of three loop diuretics (furosemide, torasemide, bumetanide) in order to reduce HF hospitalizations but also to improve symptoms and exercise capacity in patients with signs and/or symptoms of congestion. In addition, for the first time in hypertensive patients, European Society of Hypertension (ESH) guidelines recommend the use of torasemide. This review aimed to summarize the mode of action of loop diuretics, to present their pharmacokinetic characteristics, and to discuss their place in the management of arterial hypertension and heart failure, with special emphasis however on torasemide.

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