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

  • PRUDENCE A RODRIGUES Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India.
  • SOUMYA GK Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India.
  • NADIA GRACE BUNSHAW Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India.
  • SARANYA N Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India.
  • SUJITH K Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamil Nadu, India.
  • SHANMUGA SUNDARAM R Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.

Abstract

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.

Keywords: Acute decompensated heart failure, Loop diuretics, Renal dysfunction, Serum creatinine

References

1. Meyer TE. Approach to Acute Decompensated Heart Failure in Adults. Waltham, MA: UpToDate; 2019.
2. Han SW, Ryu KH. Renal dysfunction in acute heart failure. Korean Circ J 2011;41:565-74.
3. Shirakabe A, Hata N, Kobayashi N, Shinada T, Tomita K, Tsurumi M, et al. Prognostic impact of acute kidney injury in patients with acute decompensated heart failure. Circ J 2013;77:687-96.
4. Damman K, Navis G, Smilde TD, Voors AA, van der Bij W, van Veldhuisen DJ, et al. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail 2007;9:872-8.
5. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011;364:797-805.
6. Felker GM, O’Connor CM, Braunwald E, Heart Failure Clinical Research Network Investigators. Loop diuretics in acute decompensated heart failure: Necessary? Evil? A necessary evil? Circ Heart Fail 2009;2:56-62.
7. Peacock WF, Costanzo MR, De Marco T, Lopatin M, Wynne J, Mills RM, et al. Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure: Insights from the ADHERE registry. Cardiology 2009;113:12-9.
8. Krumholz HM, Chen YT, Vaccarino V, Wang Y, Radford MJ, Bradford WD, et al. Correlates and impact on outcomes of worsening renal function in patients and gt; or =65 years of age with heart failure. Am J Cardiol 2000;85:1110-3.
9. Roy AK, Mc Gorrian C, Treacy C, Kavanaugh E, Brennan A, Mahon NG, et al. A comparison of traditional and novel definitions (RIFLE, AKIN, and KDIGO) of acute kidney injury for the prediction of outcomes in acute decompensated heart failure. Cardiorenal Med 2013;3:26-37.
10. Kalra OP, Aggarwal A. Rational use of diuretics and pathophysiology of edema. Medicine 2012;22:601-10.
11. Damman K, Kjekshus J, Wikstrand J, Cleland JG, Komajda M, Wedel H, et al. Loop diuretics, renal function and clinical outcome in patients with heart failure and reduced ejection fraction. Eur J Heart Fail 2016;18:328-36.
12. Onuigbo MAC, Agbasi N, Sengodan M, Rosario KF. Acute kidney injury in heart failure revisited-the ameliorating impact of ”Decongestive diuresis” on renal dysfunction in Type 1 acute cardiorenal syndrome: Accelerated rising pro B naturetic peptide is a predictor of good renal prognosis. J Clin Med 2017;6:E82.
13. El-Refai M, Krivospitskaya O, Peterson EL, Wells K, Williams LK, Lanfear DE, et al. Relationship of loop diuretic dosing and acute changes in renal function during hospitalization for heart failure. J Clin Exp Cardiolog 2011;2:1000164.
14. Damman K, Valente MA, Voors AA, O’Connor CM, van Veldhuisen DJ, Hillege HL, et al. Renal impairment, worsening renal function, and outcome in patients with heart failure: An updated meta-analysis. Eur Heart J 2014;35:455-69.
15. Al-Naher A, Wright D, Devonald MAJ, Pirmohamed M. Renal function monitoring in heart failure what is the optimal frequency? A narrative review. Br J Clin Pharmacol 2018;84:5-17.
16. Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R, et al. Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance. Eur J Heart Fail 2008;10:188-95.
17. Ahmed A, Campbell RC. Epidemiology of chronic kidney disease in heart failure. Heart Fail Clin 2008;4:387-99.
18. Sanjay K, Surendra H. An elevated pulse pressure: A major risk factor for cardiovascular diseases. Int J Pharm Pharm Sci 2013;5:5-11.
19. Mohd M, Normi H. Effect of angiotensin converting enzyme inhibitors and angiotensin-ii receptor blockers on proteinuria of hypertensive patients in standard care practice. Int J Pharm Pharm Sci 2015;11:40-3.
20. Schmidt M, Mansfield KE, Bhaskaran K, Nitsch D, Sørensen HT, Smeeth L, et al. Serum creatinine elevation after renin-angiotensin system blockade and long term cardiorenal risks: Cohort study. BMJ 2017;356:j791.
Statistics
433 Views | 113 Downloads
Citatons
How to Cite
PRUDENCE A RODRIGUES, SOUMYA GK, NADIA GRACE BUNSHAW, SARANYA N, SUJITH K, and SHANMUGA SUNDARAM R. “ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 12, no. 12, Oct. 2019, pp. 61-63, doi:10.22159/ajpcr.2019.v12i12.35574.
Section
Original Article(s)