2015


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2015/№1

Effect of combination diuretic therapy on the prognosis in patients with cirrhosis, chronic kidney disease, and pneumonia associated with circulatory decompensation

Arutyunov A. G., Dragunov D. O., Arutyunov G. P., Rylova A. K., Sokolova A. V.
State Budgetary Educational Institution of Higher Professional Education "N. I. Pirogov Russian National Research Medical University" of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997

Keywords: circulatory decompensation, pneumonia, spironolactone, torasemide, furosemid, chronic kidney disease, CHF, cirrhosis

DOI: 10.18087/rhfj.2015.1.2020

Background. Selection of a safe and prognostically more effective combination of diuretics with consideration of their pharmacokinetic characteristics is an important task. Aim. To analyze clinical efficacy and prognostic significance for a combination of spironolactone and the loop diuretics, furosemid or torasemid SR, in patients with the clinical phenotype of cirrhosis + circulatory decompensation (CD) + pneumonia + IIIb chronic kidney disease (CKD). Materials and methods. The study included 39 patients divided into two groups with cirrhosis, CD syndrome, pneumonia, and IIIb CKD. Patients received the diuretic treatment with furosemid (S+F group, n=19) or torasemid SR (S+ТSR group, n=20). All patients received spironolactone. Plasma potassium and sodium, fractional excretion of uric acid (FE UA), and urine osmolarity were measured, and cirrhosis severity was determined. Results. During 10 days of intensive combination diuretic treatment, hyponatremia was observed in 71.43 % of patients in the S+F group and in 28.57 % of patients in the S+ТSR group (p=0.36); hypokalemia was observed in 55 % and 34 % of patients, respectively (p=0.24). Progression of hepatic encephalopathy was observed in 3 patients in the S+F group and one patient in the S+TSR group. Risk for more severe class of cirrhosis was significantly higher in the S+F group (OR=5.50; CI 2.65, 11.37) compared with the S+ТSR group (OR=0.182; CI 0.088, 0.376; p=0.03). The area under the osmolarity-time curve was significantly smaller in the S+F group than in the S+TSR group (18817.5 vs. 19747 units / m2, p<0.05). FE UA levels were significantly lower in the S+F treatment group than in the S+TSR treatment group (12.73±2.42 % and 14.9±1.95 %, respectively, p=0.006). Risk of in-hospital death was higher in the S+F group (21 %; OR=5.06; CI 1.57, 16.32) than in the S+ТSR group (5 %; OR=0.19; CI 0.06, 0.63). Conclusion. The phenotype of cirrhosis + pneumonia + CKD + CD is prognostically highly unfavorable; death rate was 34.3 % in the acute decompensation period and the 60 day death rate was 59.3 %
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Arutyunov A. G., Dragunov D. O., Arutyunov G. P. et al. Effect of combination diuretic therapy on the prognosis in patients with cirrhosis, chronic kidney disease, and pneumonia associated with circulatory decompensation. Russian Heart Failure Journal. 2015;16 (1):11–21

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