CARDIORENAL SYNDROME TYPE 2: PATHOGENETIC APPROACH TO DIURETIC THERAPY

Zhdan V. M., Katerenchuk O. I., Kiryan O. A., Haymenova G. S.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The problem of treatment of patients suffering on cardiorenal syndrome with the presence of refractory edema syndrome is described in the article. Effectiveness and safety of adding xipamide to loop diuretic therapy in patients with chronic heart failure and secondary renal dysfunction have been investigated. The diuretic action of xipamid is due to suppressed reabsorption of sodium and chloride ions, as well as water in the initial part of the distal renal tubules, that leads to polyuria due to osmotically bound water. It is important that it’s possible to use xipamide, regardless of the glomerular filtration rate value and tubular secretion rate, so it allows it to be used in most patients with chronic heart failure who are refractory to loops diuretic treatment. The aim of the study: to evaluate the efficacy and safety of adding xipamide to complex drug therapy in patients with chronic heart failure and secondary renal dysfunction with refractory edema syndrome. Methods. Enrollment of patients to the study was carried out at the therapeutic department of the Central Clinical Hospital of the Poltava District. Patients were divided equally on the study group (receiving xipamide + loop diuretic) and control group (without xipamide treatment). All enrolled patients received guideline-based treatment of chronic heart failure, included treatment with aldosterone antagonists for patients with reduced left ventricle ejection fraction (these patients were also equally divided between groups). As an experimental therapeutic tactic, xipamide was administered in a dose of 20 mg once daily followed by titration of up to 40 and 80 mg (depending on therapeutic effect and tolerability) in 7 days intervals. Results: 28 patients were enrolled to the study. The average age was 62,43±6,37 years, gender: men – 16, and women – 12 people. The average duration of chronic heart failure was 5,32±1,16 years. As the main cause of chronic heart failure in 15 patients coronary arteries disease was diagnosed and 13 patients had dilated cardiomyopathy. During treatment period the positive effects of combination therapy on the dynamics of water balance and the state of autonomic regulation were obtained. The combination of xipamide (with dose titration) to the loop diuretic resulted in a more pronounced diuretic effect beginning from the 1 day of treatment (more prominent positive changes in 24-hours fluid balance were observed). It was combined with a decrease in the severity of hypersympathetic state and normalization of autonomic regulation beginning from the day 10 of treatment. The proposed diuretic treatment included xipamide was not accompanied by clinically significant disorders of electrolites metabolism. Conclusion: xipamide is effective and safe in patients with type 2 cardiorenal syndrome for treatment of resistant edema syndrome by using in combination with loop diuretic.

cardiorenal syndrome, chronic heart failure, xipamide.

1. Hadjiphilippou S, Kon SP. Cardiorenal syndrome: review of our current understanding. J R Soc Med. 2016 Jan;109(1):12-7.
2. Orvalho JS, Cowgill LD. Cardiorenal Syndrome: Diagnosis and Management. Vet Clin North Am Small Anim Pract. 2017 Sep;47(5):1083-102.
3. Kumar U, Wettersten N, Garimella PS. Cardiorenal Syndrome: Pathophysiology. Cardiol Clin. 2019 Aug;37(3):251-65.
4.  Zhdan VM, Kitura YM, Babanina MY, Kitura OY, Volchenko GV, Tkachenko MV, Shylkina LM. Aktualni pytannya kardiologiyi v praktyci simejnogo likarya. 2th ed. Poltava: FOP Myronenko IG; 2017. 248 s. [in Ukrainian].
5. Casu G, Merella P. Diuretic Therapy In Heart Failure – Current Approaches. European Cardiology Review. 2015;10(1):42-7.
6. Ivanov DD. Sleduiushchyi shah v lechenyy boleznei pochek. Pochki. 2016;2(16):10-3. [in Russian].
7. Knauf H, Mutschler E. Mechanism of action of xipamide and its classification as a «low ceiling diuretic». Pharmacodynamic-pharmacokinetic studies in healthy volunteers and in kidney and liver patients. Arzneimittelforschung. 2005;55(1):1-14.
8. Fushtey IM, Podsevahina SL, Chabannaya ES, Tkachenko OV. Diureticheskaya terapiya hronicheskoy serdechnoy nedostatochnosti u patsientov s arterialnoy gipertenziey v sochetanii s saharnyim diabetom 2-go tipa. Liky Ukrainy. 2017;1(207):50-4. [in Russian].

«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 97-100 pages, index UDK 616.12-008.331.1-085.225.2

10.29254/2077-4214-2019-3-152-97-100