The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Randomized Trial

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 benets compared with stepped-dose furosemide (SF). Methods: In a 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 rst 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. All were similar between Adverse events no =

Background: Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine that is positively associated with inflammation.This study evaluated the association between GDF-15 and in-hospital mortality among patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).
Methods: Among the multicenter prospective CRRT cohort between 2017 and 2019, 66 patients whose blood sample was available were analyzed.Patients were divided into three groups according to the GDF-15 concentrations.In-hospital mortality was compared using Cox proportional hazards regression model.
Background: In cardiorenal syndrome 1 (CRS1), is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF) Methods: In a double-blind randomized controlled trial of CRS1 patients were allocated 1:1 to SF or CD.The SF group received a continuous infusion of furosemide 100mg 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 vascular decongestion.
Results: From July 2017 to February 2020, 80 patients were randomized, 40 to SF and 40 to CD group.Groups were similar at baseline and had several very highrisk features.Their mean age 59 ± 14.5 years; 37 were men (46.2%).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).
Conclusions: In patients with SCR-1 and a high risk of resistance to diuretics, the use of CD compared to SF offers the same results of renal recovery, diuresis, vascular decongestion and adverse events, and it can be considered an alternative treatment.

Figure 1 .
Figure 1.Receiver operating characteristic curves of prognostic predictors for in-hospital mortality.