Transl Clin Pharmacol.  2017 Mar;25(1):28-33. 10.12793/tcp.2017.25.1.28.

Hydrochlorothiazide does not increase furosemide's effects in end-stage renal disease

• Huh W
• Oh HY
• Han JS
• Jang IJ
• Yim DS

• KMID: 2411416
• DOI: http://doi.org/10.12793/tcp.2017.25.1.28

Abstract

Diuretic therapy for the treatment of edema in patients with end-stage renal disease (ESRD) is unsatisfactory, and a combination of thiazide and loop diuretics may produce better clinical effects. To evaluate the influence of thiazide on loop diuretic therapy for ESRD, we performed a crossover study of furosemide versus hydrochlorothiazide plus furosemide treatment. The diuretic effects of furosemide (160 mg i.v.) alone versus a combination of hydrochlorothiazide (100 mg p.o.) and furosemide were studied in ten ESRD patients with proteinuria greater than 1 g/day. The diuretic effects were compared for 24 h urine volume and electrolyte excretion. To detect the influence of thiazide that may have been obscured in the widely dispersed data, pharmacodynamic analysis of urine furosemide excretion rate versus fractional excretion of sodium (FeNa) was also performed using mixed-effect modeling. Combination therapy was not significantly different from furosemide monotherapy in terms of 24 h urine volume, chloride, or sodium excretion. Hydrochlorothiazide was not a significant covariate in the furosemide effect for the pharmacodynamic model. In patients with ESRD and severe proteinuria (>1,000 mg/day), the combination of hydrochlorothiazide with furosemide therapy did not increase the diuretic effect of furosemide.

Keyword

Furosemide; Thiazide; ESRD

MeSH Terms

Cross-Over Studies
Diuretics
Edema
Furosemide
Humans
Hydrochlorothiazide*
Kidney Failure, Chronic*
Proteinuria
Sodium
Sodium Potassium Chloride Symporter Inhibitors
Diuretics
Furosemide
Hydrochlorothiazide
Sodium
Sodium Potassium Chloride Symporter Inhibitors

Figure

• 

  Figure 1 Furosemide excretion rate (closed circles) and FeNa (fractional excretion of sodium, open circles) observed with and without hydrochlorothiazide treatment. (Means ± S.D.)

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