累加白蛋白增强低白蛋白血症慢性肾脏病患者呋塞米的利尿效果：一项随机对照研究。
The added-up albumin enhances the diuretic effect of furosemide in patients with hypoalbuminemic chronic kidney disease: a randomized controlled study.
机构信息
Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
BMC Nephrol. 2012 Aug 29;13:92. doi: 10.1186/1471-2369-13-92.
BACKGROUND
Chronic kidney disease (CKD) with edema is a common clinical problem resulting from defects in water and solute excretion. Furosemide is the drug of choice for treatment. In theory, good perfusion and albumin are required for the furosemide to be secreted at the tubular lumen. Thus, in the situation of low glomerular filtration rate (GFR) and hypoalbuminemia, the efficacy of furosemide alone might be limited. There has been no study to validate the effectiveness of the combination of furosemide and albumin in this condition.
METHODS
We conducted a randomized controlled crossover study to compare the efficacy of diuretics between furosemide alone and the combination of furosemide plus albumin in stable hypoalbuminemic CKD patients by measuring urine output and sodium. The baseline urine output/sodium at 6 and 24 hours were recorded. The increment of urine output/sodium after treatment at 6 and 24 hours were calculated by using post-treatment minus baseline urine output/sodium at the corresponding period.
RESULTS
Twenty-four CKD patients (GFR = 31.0 ± 13.8 mL/min) with hypoalbuminemia (2.98 ± 0.30 g/dL) were enrolled. At 6 hours, there were significant differences in the increment of urine volume (0.47 ± 0.40 vs 0.67 ± 0.31 L, P < 0.02) and urine sodium (37.5 ± 29.3 vs 55.0 ± 26.7 mEq, P < 0.01) between treatment with furosemide alone and with furosemide plus albumin. However, at 24 hours, there were no significant differences in the increment of urine volume (0.49 ± 0.47 vs 0.59 ± 0.50 L, P = 0.46) and urine sodium (65.3 ± 47.5 vs 76.1 ± 50.1 mEq, P = 0.32) between the two groups.
CONCLUSION
The combination of furosemide and albumin has a superior short-term efficacy over furosemide alone in enhancing water and sodium diuresis in hypoalbuminemic CKD patients.
TRIAL REGISTRATION
The Australian New Zealand Clinical Trials Registration (ANZCTR12611000480987).
背景
由水和溶质排泄缺陷引起的伴有水肿的慢性肾脏病（CKD）是一种常见的临床问题。呋塞米是治疗的首选药物。理论上，呋塞米在管腔中分泌需要良好的灌注和白蛋白。因此，在肾小球滤过率（GFR）低和低白蛋白血症的情况下，单独使用呋塞米的疗效可能受到限制。尚未有研究验证在这种情况下呋塞米和白蛋白联合使用的有效性。
方法
我们进行了一项随机对照交叉研究，通过测量尿量和钠来比较单独使用呋塞米和呋塞米联合白蛋白在稳定的低白蛋白血症 CKD 患者中的利尿剂疗效。记录治疗前 6 小时和 24 小时的基础尿量/钠。通过用相应时间段的治疗后减去基础尿量/钠来计算治疗后 6 小时和 24 小时的尿量/钠增加量。
结果
共纳入 24 例 CKD 患者（GFR = 31.0±13.8 mL/min）伴有低白蛋白血症（2.98±0.30 g/dL）。在 6 小时时，单独使用呋塞米和呋塞米联合白蛋白治疗的尿量增加量（0.47±0.40 与 0.67±0.31 L，P<0.02）和尿钠增加量（37.5±29.3 与 55.0±26.7 mEq，P<0.01）存在显著差异。然而，在 24 小时时，两组间尿量增加量（0.49±0.47 与 0.59±0.50 L，P=0.46）和尿钠增加量（65.3±47.5 与 76.1±50.1 mEq，P=0.32）无显著差异。
结论
与单独使用呋塞米相比，低白蛋白血症 CKD 患者中呋塞米联合白蛋白在短期增强水和钠利尿方面具有更好的疗效。
试验注册
澳大利亚和新西兰临床试验注册（ANZCTR12611000480987）。
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