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A study by UT Health San Antonio found that higher doses of spironolactone, a diuretic (water tablet), may prevent the need for dialysis in some heart failure patients. The aggressive approach has been successful in relieving fluid overload safely and effectively in patients who do not respond to conventional diuretics.
The results are in the newspaper Annals of Internal Medicine. Specialists in kidney and cardiovascular disease from UT Health San Antonio Lab conducted a pilot study in 19 patients to show that higher doses of spironolactone, which prevents the reabsorption of excess salt in the kidneys and maintained the potbadium levels, could be used safely in these very sick patients. admit to the hospital with exacerbation of heart failure and do not respond to conventional diuretics.
Spironolactone is usually given to this type of patients at doses of 25 to 50 milligrams. In this study, the dose was increased to 100 mg and even 200 milligrams in some jurisdictions.
sYMPTOMS
"Heart failure patients are burdened with excess fluid (salt and water) on the body, making them breathless, unable to walk, and unable to stay flat," said Shweta Bansal, MD, professor. Associated with the Nephrology Division of UT Health San Antonio. "They are miserable because of shortness of breath and distension of the abdomen and legs."
Generally, the treatment consists of a diet low in salt and diuretics. Furosemide (Lasix brand) is one of the most commonly used drugs. When patients are admitted to the hospital, they are monitored according to this scheme and generally improve.
But about 15% to 20% of patients are not getting better, said Dr. Bansal. They continue to have a liquid overload.
"The reason is that they become resistant to commonly used loop diuretics, and a very high rate of aldosterone is one of the main reasons for this resistance," he said. she said.
Target a different mechanism
The kidneys are made up of millions of tiny tubules called nephrons. Nephrons consist of four main segments, including a part called the Henle loop, where 20 to 25% of the salt reabsorption takes place. The loop diuretics target this section.
Spironolactone inhibits the action of aldosterone, a hormone that allows the kidney to excrete too much potbadium and retain salt in the distal segment, another part of the nephrons.
& # 39; Significant improvement & # 39;
Study participants who did not respond to standard treatment received spironolactone at high doses and monitoring urinary flow and respiration. "Most of them have had a dramatic increase in their urinary output and a significant improvement in their shortness of breath," said Dr. Bansal. "We believe that some patients might avoid needing dialysis if they are treated this way."
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Material provided by Health Sciences Center of the University of Texas at San Antonio. Note: Content can be changed for style and length.
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