Combined Use Of Diuretics Research Articles

Acute kidney injury in patients with cancer receiving anti-PD-1/PD-L1 antibodies: incidence, risk factors, and prognosis

Anti-PD-1/PD-L1 antibodies are widely used in anti-cancer therapy. While they have improved cancer prognoses, immune-related adverse events, which can cause acute kidney injury (AKI), cannot be ignored. The purpose of this retrospective cohort study was to assess the incidence, risk factors, and prognosis of AKI associated with anti-PD-1/PD-L1 antibodies. Patients who received anti-PD-1/PD-L1 antibody treatment at our hospital between January 2018 and December 2022 were enrolled. Clinical information, combined medications, concomitant diseases, tumor types, and laboratory indicators were collected from patient records, and the incidence of AKI was determined. The risk factors for AKI were assessed using univariate and multivariate logistic regression analyses. Overall, 1418 patients were enrolled. The median follow-up time was 112 days and 92 (6.5%) developed AKI. The median time from the initial anti-PD-1/PD-L1 antibody treatment to AKI was 99.85 days. Head and neck cancer and combined use of diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), lower hemoglobin level, and other types of chemotherapeutic drugs were independent risk factors for AKI. The complete recovery, partial recovery, non-recovery, and unknown AKI rates were 7.6%, 28.3%, 52.2%, and 11.9%, respectively. Kidney biopsies were performed on two patients with AKI and pathology confirmed diagnosis of acute tubulointerstitial nephritis. In this cohort, AKI was not uncommon in patients treated with anti-PD-1/PD-L1 antibodies; therefore, it is necessary to monitor renal function and identify AKI early, especially in patients with head and neck tumors. Improving anemia and minimizing the use of diuretics, NSAIDs, and chemotherapeutics may reduce AKI.

The Neurohormonal Overactivity Syndrome in Heart Failure.

Heart failure (HF) is categorized arbitrarily based on the left ventricular ejection fraction (LVEF) in HF with reduced (HFrEF; LVEF < 40%), mildly reduced (HFmrEF; LVEF 40-49%), or preserved ejection fraction (HFpEF; LVEF ≥ 50%). In this opinion paper, based on (patho)physiological considerations, we contend that the neurohormonal overactivity syndrome (NOHS), which is present in all symptomatic HF patients irrespective of their LVEF, not only contributes to the development of signs and symptoms but it is also a major determinant of patients' outcomes. In this regard, NHOS is the only currently available treatment target in HF and should be combatted in most patients with the combined use of diuretics and neurohormonal inhibitors (β-blockers, angiotensin receptor-neprilysin inhibitor/angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoid antagonists, and sodium-glucose co-transporter 2 inhibitors). Unfortunately, despite the advances in therapeutics, HF mortality remains high. Probably machine learning approaches could better assess the multiple and higher-dimension interactions leading to the HF syndrome and define clusters of HF treatment efficacy.

The incidence of acute kidney injury in hospitalized patients receiving aminoglycoside antibiotics: a retrospective study.

Our aim is to investigate the incidence and risk factors of acute kidney injury (AKI) in hospitalized patients who received aminoglycoside antibiotics. A retrospective analysis was performed on the electronic medical record information of inpatients who received aminoglycoside (AG) antibiotics in our center from January 2018 to December 2020. The diagnosis of AKI was based on serum creatinine changes. Several statistical methods, including chi square test and two sample Wilcoxon rank sum test, were used to evaluate the epidemiological characteristics of aminoglycosides associated AKI. The multivariate logistic regression analysis was used to screen the risk factors. Finally, 8,040 patients who received AGs were included in the study. Among them, 494 patients (6.14%) were judged as incidence with AKI, while only 29 patients were diagnosed with AKI in the medical record. The multiple logistic regression analysis suggested that admission to ICU, complicated with diabetes mellitus, heart failure, anemia, shock, combined use of diuretics, β-lactam antibiotics, proton pump inhibitors were independent risk factors for AKI related to aminoglycosides. It is urgent to improve the understanding and attention of AKI for medical workers, and the assessment of risk factors before the use of aminoglycosides should be contributed to the early prevention, diagnosis, and treatment of AKI.

Clinical-pharmacological priorities in the election of blockators of the renin-angiotenzine system and diuretics in patients with uncompleted hypertension

The article discusses the problem of using ACE inhibitors and diuretics in arterial hypertension. Analysis of the position of doctors when prescribing ACE inhibitors and diuretics showed its compliance with current national guidelines for the treatment of hypertension. Physicians use more adequate criteria for antihypertensive drugs usage. There were no non-rational use of diuretics in combination, regardless of indications and contraindications. If there are indications for the use of a diuretic and a preparation of ACE inhibitors, you have to make greater use of fixed combinations of drugs. The article discusses the results of clinical efficacy studies of perindopril and indapamide in clinical practice. Noliprel® forte is an effective antihypertensive medication, not only reducing BP, but also organoprotective aim and good tolerability in wide range of patients with arterial hypertension.

Клинико-фармакологические приоритеты в выборе блокаторов ренин-ангиотензиновой системы и диуретиков у пациентов с неосложненной гипертонической болезнью

The article discusses the problem of using ACE inhibitors and diuretics in arterial hypertension. Analysis of the position of doctors when prescribing ACE inhibitors and diuretics showed its compliance with current national guidelines for the treatment of hypertension. Physicians use more adequate criteria for antihypertensive drugs usage. There were no non-rational use of diuretics in combination, regardless of indications and contraindications. If there are indications for the use of a diuretic and a preparation of ACE inhibitors, you have to make greater use of fixed combinations of drugs. The article discusses the results of clinical efficacy studies of perindopril and indapamide in clinical practice. Noliprel® forte is an effective antihypertensive medication, not only reducing BP, but also organoprotective aim and good tolerability in wide range of patients with arterial hypertension.

Effects of short-term addition of NSAID to diuretics and/or RAAS-inhibitors on blood pressure and renal function

The combined post-operative use of diuretics and/or renin-angiotensin-aldosterone system (RAAS) inhibitors may increase the risk of nonsteroidal anti-inflammatory drug (NSAID) associated renal failure because of a drug-drug interaction. The aim of this study was to investigate the effect of the short-term (<4 days) post-operative combined use of NSAIDs with diuretics and/or RAAS inhibitors on renal function and blood pressure. One teaching hospital in the Netherlands. The study-design was a prospective, observational cohort-study. Based on postoperative treatment with NSAIDs, the intervention-group was compared to a control-group (no NSAIDs treatment). Systolic blood pressure and renal function expressed by the estimated glomular filtration rate (eGFR) calculated with the modification of renal desease formula. 97 patients were included in the intervention-group, 53 patients in the control-group. Patient characteristics were comparable except for one variable: 'combined use of a diuretic with a RAAS inhibitor' which was higher in the control-group (62 vs. 43 %, p = 0.046). Odds ratio for clinically relevant increase in systolic blood pressure was 0.66 (CI95 % 0.3-1.5). Odds ratio for clinical relevant decrease in renal function was 2.44 (CI95 % 1.1-5.2). On day 4 eGFR of 3 patients in the intervention- and 1 in the control-group was <50 ml/min/1.73 m(2). Odds ratios showed no significant difference of a clinically relevant increase in systolic blood pressure but showed a higher risk for a clinically relevant decrease in renal function in the intervention group. However this decrease resulted in a relevant impaired renal function (<50 ml/min/1.73 m(2)) in only 3 patients in the interventiongroup and 1 patient in the control-group. In the post-operative patient, without preexisting impaired renal function, concurrent diuretics and/or renin-angiotensinaldosterone system inhibitor therapy can be combined with short-term NSAID treatment.

Target blood pressure attainment in diabetic hypertensive patients: need for more diuretics?

To determine target blood pressure attainment and to evaluate blood pressure control relative to type of therapy among diabetic hypertensive patients. An observational retrospective study of all diabetic hypertensive patients visiting Al-Watani governmental medical center from August 01, 2006 until August 01, 2007. The blood pressure (BP) measurement made during the patient's recent visit and documented in the medical files was used in the study. Controlled BP values for hypertensive patients with diabetes mellitus were defined per JNC 7 guidelines: 130/80 mmHg or lower. Proportions of use of 5 different antihypertensive drug classes were compared between patients with controlled and uncontrolled BP. Of the 311 patients, 79 (25.4%) had their BP controlled. No significant differences in age, gender, body weight, duration of hypertension or diabetes, renal function, average number of anti-hypertensive medications and doses of most commonly reported antihypertensive medications were found between controlled and uncontrolled BP groups. ACE-I/ARB was the most commonly used drug class in both groups. Overall, the use of ACE-I/ARB, beta-blockers, calcium channel blockers, alpha-blockers and multi drug regimens were also not significantly different between the controlled and uncontrolled groups. However, overall use of diuretics was significantly higher in controlled group than uncontrolled group (59.5% versus 45.7%, p < 0.001). Despite the common use of ACE-I/ ARB as recommended per JNC 7th report, the majority of the patients had uncontrolled BP. Diuretics is an important drug class in attaining target BP. Use of diuretics in combination with ACE-I as well as drug compliance needs to be emphasized and encouraged.

NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics.

Both diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, in particular among the elderly. The use of NSAIDs may decrease the efficacy of diuretics and induce congestive heart failure (CHF) in patients treated with diuretics. To investigate the risk of CHF associated with combined use of diuretics and NSAIDs in patients older than 55 years. We conducted a study in a base cohort of 10,519 recipients of diuretics and NSAIDs identified in the PHARMO database during the period from 1986 through 1992. The incidence density of hospitalizations for CHF during exposure to both diuretics and NSAIDs (index) was compared with that during exposure to diuretics only (reference). We found an overall increased risk of hospitalization for CHF during periods of concomitant use of diuretics and NSAIDs compared with use of diuretics only (crude relative risk, 2.2; 95% confidence interval, 1.7-2.9). After adjusting for cofactors including age, sex, history of hospitalization, and drug use, a 2-fold increased risk remained (relative risk, 1.8; 95% confidence interval, 1.4-2.4). Use of NSAIDs in elderly patients taking diuretics is associated with a 2-fold increased risk of hospitalization for CHF, especially in those with existing serious CHF.

The rationale for combined use of diuretics, digitalis, and vasodilators in congestive heart failure

The rationale for combined use of diuretics, digitalis, and vasodilators in congestive heart failure

Antihypertensive effects of captopril in combination with diuretics in spontaneously hypertensive rats.

To examine the antihypertensive effects of captopril, when used in combination with diuretics, an oral dose of the agent (30 mg/kg) was given to spontaneously hypertensive rats pretreated for 1 week with trichlormethiazide (TCTZ), hydrochlorothiazide (HCTZ), furosemide, or water. One-week treatment with diuretics did not lower blood pressure, but potentiated the anti-hypertensive action of captopril in magnitude as well as duration. The degree of potentiation was in the following order: furosemide greater than or equal to HCTZ greater than TCTZ. Plasma renin concentration (PRC) prior to the administration of captopril was highest in the furosemide group, followed by the HCTZ, TCTZ, and control groups, in this order. When data from four groups were taken together, the reduction of blood pressure following captopril administration was closely related to PRC before administration. These data suggest that repeated administration of diuretics renders the maintenance of blood pressure more dependent on the renin-angiotensin system without affecting blood pressure and that this situation underlies the potentiation of the antihypertensive action of captopril by combined use of diuretics. There was no qualitative difference between furosemide and thiazides in the potentiation of anti-hypertensive action of captopril.

Central Registry for Small-Bowel Ulcers

To the Editor:— In recent years there seems to be a striking increase in the clinical incidence of small-bowel ulceration with attendant stenosis. Lindholmer, Nyman, and Raf in Sweden, and Baker and associates in this country have drawn attention to a possible relationship between this entity and the use of thiazide diuretics in combination with potassium. Because thiazide drugs constitute such and important tool in our therapeutic armamentarium, it is imperative that the available evidence be reviewed and any possible relationships be determined. We are now concerned with a group of more than 80 patients, comprising ( 1) those already reported (see JAMA 190: 586-590 [Nov 16] 1964) and (2) those to be reported by Morganstern, Freilich, and Panish from Los Angeles, Handel from Detroit, and the group from Brooklyn. While available information is imperfect, the patients from these various centers appear to be similar in a number of ways: