The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial

Jonathan S Chávez-Iñiguez, Miguel Ibarra-Estrada, Sergio Sánchez-Villaseca, Gregorio Romero-González, Jorge J Font-Yañez, Andrés De la Torre-Quiroga, Andrés Aranda-G de Quevedo, Alexia Romero-Muñóz, Pablo Maggiani-Aguilera, Gael Chávez-Alonso, Juan Gómez-Fregoso, Guillermo García-García, Jonathan S Chávez-Iñiguez, Miguel Ibarra-Estrada, Sergio Sánchez-Villaseca, Gregorio Romero-González, Jorge J Font-Yañez, Andrés De la Torre-Quiroga, Andrés Aranda-G de Quevedo, Alexia Romero-Muñóz, Pablo Maggiani-Aguilera, Gael Chávez-Alonso, Juan Gómez-Fregoso, Guillermo García-García

Abstract

Aim: The main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion. It is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF).

Methods: In a pilot double-blind randomized controlled trial of CRS1 patients were allocated in a 1:1 fashion to SF or CD. The SF group received a continuous infusion of furosemide 100 mg during the first day, with daily incremental doses to 200 mg, 300 mg and 400 mg. The CD group received a combination of diuretics, including 4 consecutive days of oral chlorthalidone 50 mg, spironolactone 50 mg and infusion of furosemide 100 mg. The objectives were to assess renal function recovery and variables associated with vascular decongestion.

Results: From July 2017 to February 2020, 80 patients were randomized, 40 to the SF and 40 to the CD group. Groups were similar at baseline and had several very high-risk features. Their mean age was 59 ± 14.5 years, there were 37 men (46.2%). The primary endpoint occurred in 20% of the SF group and 15.2% of the DC group (p = 0.49). All secondary and exploratory endpoints were similar between groups. Adverse events occurred frequently (85%) with no differences between groups (p = 0.53).

Conclusion: In patients with CRS1 and a high risk of resistance to diuretics, the use of CD compared to SF offers the same results in renal recovery, diuresis, vascular decongestion and adverse events, and it can be considered an alternative treatment. ClinicalTrials.gov with number NCT04393493 on 19/05/2020 retrospectively registered.

Keywords: Acute kidney injury; Cardio-renal syndrome; Congestive heart failure; Diuresis; Diuretics.

Conflict of interest statement

the authors declare no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT diagram of allocation groups
Fig. 2
Fig. 2
Primary endpoint Renal function recovery (sCr return to baseline value) in 80 patients with CRS1 according to allocation groups
Fig. 3
Fig. 3
Secondary endpoint in 80 patients with CRS1 according to allocation groups. 3.1) Change in urinary output (ml). 3.2) Change in A, urea; B, serum sodium; C, serum potassium and D, serum bicarbonate
Fig. 4
Fig. 4
Clinical evolution in 80 patients with CRS1 according to allocation groups. A) Dyspnea improvement, B) Renal replacement therapy, C) Intervention stopped because improvement and D) mortality
Fig. 5
Fig. 5
Exploratory analysis, changes in BNP (A) and copeptine levels (B) during the trial according to the allocation groups

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Source: PubMed

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