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Create a personal account or sign in to:. Privacy Policy. Make a comment. Mean arterial blood pressure decreased by the same amount with both diuretics. Combining furosemide and hydrochlorothiazide did not increase the efficacy of hydrochlorothiazide. Abstract Background: Loop diuretics are the drugs of choice for the treatment of hypertension in chronic renal failure patients.
The pharmacodynamics of diuretics and the physiology of sodium reabsorption in CRF make the results of our study not so unexpected. On the other hand, the braking and the rebound phenomena may account for the loss of efficacy of FUR.
We used a long-acting form of FUR but, even with this form, the half-life is not long enough to prevent the rebound phenomenon. The effectiveness of the combination is speculative, but one can imagine that if furosemide alone is ineffective in increasing sodium chloride excretion, to combine it with any other diuretics would not increase its efficacy. Mean arterial blood pressure was similarly decreased by the two diuretics.
The mechanism of the hypotensive effect of the drugs seems to be different. FUR acts mainly on blood pressure by decreasing peripheral vascular resistance while blood volume depletion seems marginal [ 11 ]. It has already been shown that the hypotensive effect of thiazides relies on their ability to induce negative sodium balance [ 12 ].
We did not have clear-cut explanations for the stable potassium levels in spite of the increase in fractional excretion of sodium. It is possible that the transtubular potassium gradient in the cortical collecting duct was low because of low availability of aldosterone in severe renal failure.
The decrease in proteinuria may be explained both by the decrease in GFR under diuretic treatments and by some changes in the renal microcirculation induced by prostaglandins or other vasoactive peptides. Hypertension associated with early stage kidney disease. Am J Med ; 61 : — The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med ; : — Renoprotection: one or many therapies. Kidney Int ; 59 : — Wilcox CS.
The Kidney , 4th edn. Saunders Co. Mechanism of impaired natriuretic response to furosemide during prolonged therapy. Kidney Int ; 36 : — Kaissling B, Stanton BA. Adaptation of distal tubule and collecting duct to increased sodium delivery.
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Eur J Clin Pharmacol ; 46 : 9 — Knauf H, Mutschler E. Diuretic effectiveness of hydrochlorothiazide and furosemide alone and in combination in chronic renal failure. J Cardiovasc Pharmacol ; 26 : — Vascular effects of loop diuretics. Cardiovasc Res ; 32 : — Bennett WM. Thiazides for hypertension with renal failure. Lancet ; 1 : Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. A randomized trial of furosemide vs hydrochlorothiazide in patients with chronic renal failure and hypertension. Bertrand Dussol , Bertrand Dussol. Email: bdussol mail.
Oxford Academic. Google Scholar. Julie Moussi-Frances. Sophie Morange. Claude Somma-Delpero. Olivier Mundler. Yvon Berland. Select Format Select format.
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