Počki (Mar 2019)
Diuretics in modern nephrology
Abstract
The paper considers the problem of using loop diuretics in patients with chronic kidney disease associated with cardiovascular risk, such as heart failure, hypertension, edema syndrome, including those against diabetes mellitus. Three therapeutic margins of torasemide and xipamide are presented, the latter can be added to torasemide to enhance the diuretic effect. The schemes of their administration and dosage of torasemide are given. On specific clinical cases, the causes and clinical situations with fluid retention in kidney diseases were identified, and the role of fluid retention in cardiovascular complications was underlined. Comparative analysis of the effectiveness of various torasemide doses, which are most often used in modern nephrology, is performed. The practice and features of their prescription in different nephrological situations, the sequence and integrity in the formation of the therapeutic effect depending on the patient’s hydration, bioimpedance data and diagnosis are presented. The therapeutic approach according to modern guidelines on cardiac insufficiency is analyzed. The need to choose torasemide dose to achieve adequate diuresis is emphasized. Attention is drawn to the possibility of the continuous administration of torasemide in patients with high levels of natriuretic peptide. In other clinical situations, the use of torasemide requires intermittent administration due to the formation of resistance to its use. It is emphasized the necessity of maintaining normonatriemia in patients who are receiving diuretics for a long time. The most common side effects of diuretics, the possibility of their avoidance and correction are described. Indices that require control when using diuretics are given. At the end of the article, there are practical recommendations for physicians, which will allow reasonably prescribe loop diuretics, in particular torasemide. The attention is focused on the wide range of torasemide doses depending on the clinical situation and estimated glomerular filtration rate in a patient with chronic kidney disease and concomitant clinical conditions. The preferred use of torasemide, xipamide, and aldosterone antagonists is recommended.
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