Bumetanide plus chlorthalidone lowers blood pressure, volume overload in patients with CKD
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As the combination of bumetanide and chlorthalidone reduced arterial pressure and volume overload in patients with advanced chronic kidney disease, it may be a better treatment when loop diuretics are insufficient, according to a speaker.
“Current treatment for hypertension and volume overload in chronic kidney disease consists of loop diuretics; nevertheless, chronic use leads to adaptive changes at the distal nephron, which in turn decreases their efficacy,” Fabio Solis-Jimenez, MD, MSc, said during a presentation at ASN Kidney Week, which was held as a virtual event. “The use of thiazide diuretics could be another treatment option in these patients.”
To assess the efficacy and safety of treatment with bumetanide and chlorthalidone, Solis-Jimenez and colleagues enrolled 32 patients in a single-center, double-blind randomized controlled trial. Patients had chronic kidney disease stages 4 or 5 and were treated with loop diuretics for a mean of 12 months. Jimenez and colleagues categorized patients into an intervention group treated with bumetanide plus chlorthalidone and a control group treated with bumetanide plus placebo for 28 days. Researchers wrote there were no significant differences between the two groups.
All patients received 3 mg of bumetanide per day, which researchers increased to 4 mg after 7 days. The intervention group received 50 mg of chlorthalidone per day, which researchers increased to 100 mg after 7 days. The primary outcome measures were volume overload and blood pressure changes, and the secondary outcome measures were fractional excretion of sodium (FENa), BNP, creatinine and GFR.
Systemic blood pressure and volume overload decreased more in patients treated with bumetanide with chlorthalidone compared with patients treated with bumetanide alone. Systemic blood pressure measures included systolic blood pressure (-26.1 mmHG vs. -10 mmHG), diastolic blood pressure (-13.5 mmHG vs. -3.4 mmHG) and mean arterial pressure (-18.1 mmHG vs. -5.4 mmHG). Volume overload measures included total body water (-4.36 L vs. 0.075 L), extracellular water (-2.55 L vs. 0.150 L) and extracellular water to total body ratio (-2.92 vs. -0.24). Solis-Jimenez said there were no significant differences between the two groups in FENa, BNP, serum creatinine, GFR and serum urea levels.
“In advanced chronic kidney disease plus hypertension patients whose treatment with loop diuretics is insufficient, combined use of bumetanide plus chlorthalidone can be useful for systemic blood pressure and volume overload control,” researchers wrote.
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Solis-Jimenez F, et al. FR-OR17. Presented at: ASN Kidney Week. Oct. 22-25 (virtual meeting).
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