Interrelation of loop diuretic half-life, natriuresis intensity and indices of the central hemodynamics in CHF patients (pilot study)
Arutyunov G. P., Oganezova L. G., Dragunov D. O.
Keywords: hemodynamics, diuretics, natriuresis, CHF
Relevance. When estimating renal function, studying of tubulointerstitial tissue (TIT) of kidney is important. Complex markers of TIT lesion are not available in the routine clinical practice, however it is possible to control electrolyte imbalances (first of all, natriuresis changes), in particular when loop diuretics are administered. Objective. Study influence of Torasemide with a different release rate (usual and sustained forms) on natriuresis and parameters of central hemodynamics in salt-sensitive AH and CHF patients. Materials and methods. Open-label randomized comparative parallel III phase clinical study in patients with essential AH II–III degree and CHF FC I–II (NYHA) included 28 patients (2 Torasemide groups: sustained Torasemide – Britomar (10 mg) – n=13 and Torasemide IR, 10 mg, n=15). Natriuresis control, estimation of salt sensitivity by Weinberger method, glomerular filtration rate (GFR) under the Mayo formula, microalbuminuria (MAU), arteriography by the applanation tonometry method. Results. Total natriuresis in the first day of sustained Torasemide administration and Torasemide IR was higher in the second group (1564.2 mmol / l vs. 2 293.5 mmol / l, р<0.05), however, natriuresis curves were different (absence of peak in the sustained Torasemide group). On the 30th study day, total daily natriuresis was significantly higher in the sustained Torasemide group (2 695.8 mmol / l vs. 1875.2 mmol / . On the 40th day of Torasemide administration, the tubular-injury marker (α-1 microglobulin, β-2 microglobulin) levels were decreased. In both groups, there were no statistically significant changes of indices of the central hemodynamics, however, in the sustained Torasemide group, the central hemodynamic indices inclined to decrease. Conclusion. Beneficial effect of sustained Torasemide on the central hemodynamic indices can be connected with absence of sodium rebound retention when this diuretic is administered, thus, absence of vascular walls do not become more rigid.
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Arutyunov G. P., Oganezova L. G., Dragunov D. O. Interrelation of loop diuretic half-life, natriuresis intensity and indices of the central hemodynamics in CHF patients (pilot study). Russian Heart Failure Journal. 2012;13(4):222-227