Division of Nephrology, Second University of Naples, Naples, Italy.
Nephrol Dial Transplant. 2011 May;26(5):1575-83. doi: 10.1093/ndt/gfq565. Epub 2010 Sep 27.
In chronic kidney disease (CKD), loop diuretics correct volume-dependent hypertension, but their effect on left ventricular mass index (LVMI) is unknown.
Forty hypertensive CKD patients (estimated creatinine clearance 60-15 mL/min/1.73 m²), treated with renin-angiotensin system (RAS) inhibitors, were randomized to receive furosemide or non-diuretic antihypertensive treatment (control group). Office blood pressure (BP) < 130/80 mmHg was pursued in both groups. Primary end point was the reduction of LVMI after 52 weeks. Secondary aims were to verify safety related to furosemide treatment and its effects on ambulatory and clinic BP and body fluid volumes.
Office BP similarly declined in the furosemide group (from 161 ± 14/80 ± 10 to 139 ± 14/74 ± 8 mmHg) and in controls (from 159 ± 16/81 ± 10 to 137 ± 16/75 ± 10 mmHg). We detected a greater reduction (P = 0.013) of LVMI in patients receiving furosemide (-7.9, IQR from -15.8 to -1.4 g/h(2.7)) than in controls (0.0, IQR from -6.2 to + 9.5 g/h(2.7), P = 0.013). Bio-impedance analysis-derived extracellular water (ECW) significantly decreased in furosemide-treated patients (from 18.7 ± 3.9 to 17.7 ± 3.3 L) while remained unchanged in the control group (from 19.5 ± 2.2 to 19.6 ± 1.9 L). Absolute change of LVMI correlated with changes of ECW in furosemide-treated patients (r = 0.458, P = 0.042) but not in controls. In the furosemide group, no patient experienced side effects requiring drug withdrawal.
In hypertensive CKD patients treated with RAS inhibitors, add-on furosemide efficaciously reduces LVMI independently from BP changes. The effect is possibly mediated by better control of volume expansion.
在慢性肾脏病（CKD）中，袢利尿剂可纠正容量依赖性高血压，但它们对左心室质量指数（LVMI）的影响尚不清楚。
40 例高血压 CKD 患者（估计肌酐清除率为 60-15ml/min/1.73m²），接受肾素-血管紧张素系统（RAS）抑制剂治疗，随机分为呋塞米或非利尿剂降压治疗（对照组）。两组均追求办公室血压（BP）<130/80mmHg。主要终点是 52 周后 LVMI 的降低。次要目的是验证与呋塞米治疗相关的安全性及其对动态和诊室 BP 及体液容量的影响。
呋塞米组的办公室 BP 同样下降（从 161±14/80±10 降至 139±14/74±8mmHg），对照组也下降（从 159±16/81±10 降至 137±16/75±10mmHg）。我们发现接受呋塞米治疗的患者的 LVMI 降低更明显（P=0.013）（-7.9，IQR 为-15.8 至-1.4g/h（2.7）），而对照组为 0.0（IQR 为-6.2 至+9.5g/h（2.7），P=0.013）。呋塞米治疗组生物电阻抗分析得出的细胞外液（ECW）显著减少（从 18.7±3.9 降至 17.7±3.3L），而对照组则无变化（从 19.5±2.2 至 19.6±1.9L）。呋塞米治疗患者的 LVMI 绝对变化与 ECW 的变化相关（r=0.458，P=0.042），但对照组则不相关。在呋塞米组，没有患者因药物不良反应而停药。
在接受 RAS 抑制剂治疗的高血压 CKD 患者中，添加呋塞米可有效降低 LVMI，与血压变化无关。其作用可能是通过更好地控制容量扩张来介导的。
