Servicio de Nefrología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
Universidad de Guadalajara, Centro Universitario de Ciencias de la Salud CUCS, Hospital 278, CP 44240, Guadalajara, Jalisco, Mexico.
BMC Nephrol. 2022 Jan 3;23(1):3. doi: 10.1186/s12882-021-02637-y.
The main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion. It is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF).
In a pilot double-blind randomized controlled trial of CRS1 patients were allocated in a 1:1 fashion to SF or CD. The SF group received a continuous infusion of furosemide 100 mg during the first day, with daily incremental doses to 200 mg, 300 mg and 400 mg. The CD group received a combination of diuretics, including 4 consecutive days of oral chlorthalidone 50 mg, spironolactone 50 mg and infusion of furosemide 100 mg. The objectives were to assess renal function recovery and variables associated with vascular decongestion.
From July 2017 to February 2020, 80 patients were randomized, 40 to the SF and 40 to the CD group. Groups were similar at baseline and had several very high-risk features. Their mean age was 59 ± 14.5 years, there were 37 men (46.2%). The primary endpoint occurred in 20% of the SF group and 15.2% of the DC group (p = 0.49). All secondary and exploratory endpoints were similar between groups. Adverse events occurred frequently (85%) with no differences between groups (p = 0.53).
In patients with CRS1 and a high risk of resistance to diuretics, the use of CD compared to SF offers the same results in renal recovery, diuresis, vascular decongestion and adverse events, and it can be considered an alternative treatment. ClinicalTrials.gov with number NCT04393493 on 19/05/2020 retrospectively registered.
1 型心肾综合征（CRS1）的主要治疗策略是血管减压。联合利尿剂序贯阻断肾小管（CD）可能与逐步增加呋塞米剂量（SF）获得相似的益处。
在一项 CRS1 患者的试点双盲随机对照试验中，患者以 1:1 的比例随机分配到 SF 或 CD 组。SF 组在第 1 天接受持续输注呋塞米 100mg，每日剂量递增至 200mg、300mg 和 400mg。CD 组接受联合利尿剂治疗，包括连续 4 天口服氯噻酮 50mg、螺内酯 50mg 和输注呋塞米 100mg。目的是评估肾功能恢复和与血管减压相关的变量。
2017 年 7 月至 2020 年 2 月，80 名患者被随机分配，40 名进入 SF 组，40 名进入 CD 组。两组在基线时相似，具有几个极高危特征。他们的平均年龄为 59±14.5 岁，其中 37 名男性（46.2%）。SF 组和 DC 组的主要终点发生率分别为 20%和 15.2%（p=0.49）。所有次要和探索性终点在两组之间相似。不良事件发生率较高（85%），两组间无差异（p=0.53）。
在对利尿剂有抵抗风险的 CRS1 患者中，与 SF 相比，使用 CD 在肾功能恢复、利尿、血管减压和不良事件方面提供了相同的结果，可以考虑作为替代治疗。ClinicalTrials.gov 于 2020 年 5 月 19 日以 NCT04393493 号进行了回顾性注册。
