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A recent study 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.
Specialists in kidney and cardiovascular disease conducted a pilot study of 19 patients to show that higher doses of spironolactone, which prevented the reabsorption of excess salt in the kidneys and maintained potbadium levels, could be used safely in these patients very sick 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 the study published in the Annals of Internal Medicine Journal, the dose was increased to 100 and even, to some administrations, even to 200 milligrams.
"Patients with heart failure come to us with excess fluid (salt and water) on their bodies, making them breathless, unable to walk and unable to stay flat. They are unhappy because of shortness of breath and distention of the abdomen and legs, "said Shweta Bansal, one of the researchers in the study.
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 percent 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.
The kidneys are made up of millions of tiny tubules called nephrons. Nephrons consist of four main segments, of which a portion, called the Henle loop, where 20-25% of the salt reabsorption occurs. 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.
Study participants who did not respond to standard therapy received high-dose spironolactone and monitoring urinary flow and respiration. "Most of them had a dramatic increase in their urine output and a significant improvement in their shortness of breath. We believe that some patients might avoid needing dialysis if they were treated this way, "said Dr. Bansal.
Posted on: August 4, 2019 09:05
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