Diuretika bei akuter und chronischer Nierenkrankheit

ZUSAMMENFASSUNG

Diuretika gehören zu den am häufigsten verordneten Wirkstoffgruppen und werden im klinischen Alltag bei Patienten mit Nierenkrankheiten routinemäßig eingesetzt. Aber was ist über ihren Einsatz bei akuter und chronischer Nierenkrankheit bekannt? Welche Wirkstoffe können sinnvoll eingesetzt werden? Welche Indikationen für den Einsatz von Diuretika gibt es bei der akuten und chronischen Nierenkrankheit? Was ist bei ihrer Verwendung bei nierenkranken Patienten zu beachten und welchen Einfluss hat eine eingeschränkte Nierenfunktion auf ihre Wirkung? Auf diese Fragen soll in diesem Artikel ausführlich eingegangen werden.

Publication History

Article published online:
14 February 2024

• Literatur

• 1 Hashemian SM, Jamaati H, Farzanegan Bidgoli B. et al Outcome of acute kidney Injury in critical care unit, based on AKI network. Tanaffos 2016; 15: 89-95
• 2 Macedo E, Malhotra R, Bouchard J. et al Oliguria is an early predictor of higher mortality in critically ill patients. Kidney Int 2011; 80: 760-767
• 3 Patschan D, Patschan S, Buschmann I. et al Loop diuretics in acute kidney injury prevention, therapy, and risk stratification. Kidney Blood Press Res 2019; 44: 457-464
• 4 Burg MB. Tubular chloride transport and the mode of action of some diuretics. Kidney Int 1976; 09: 189-197
• 5 Nielsen S, Maunsbach AB, Ecelbarger CA. et al Ultrastructural localization of Na-K-2Cl cotransporter in thick ascending limb and macula densa of rat kidney. Am J Physiol 1998; 275: F885-F893
• 6 McMahon BA, Chawla LS. The furosemide stress test: current use and future potential. Ren Fail 2021; 43: 830-839
• 7 Novak JE, Ellison DH. Diuretics in states of volume overload: core curriculum 2022. Am J Kidney Dis 2022; 80: 264-276
• 8 Shankar SS, Brater DC. Loop diuretics: from the Na-K-2Cl transporter to clinical use. Am J Physiol Renal Physiol 2003; 284: F11-F21
• 9 Schmidt C, Hocherl K, Schweda F. et al Regulation of renal sodium transporters during severe inflammation. J Am Soc Nephrol 2007; 18: 1072-1083
• 10 Rose HJ, O’Malley K, Pruitt AW. Depression of renal clearance of furosemide in man by azotemia. Clin Pharmacol Ther 1977; 21: 141-146
• 11 Hasannejad H, Takeda M, Taki K. et al Interactions of human organic anion transporters with diuretics. J Pharmacol Exp Ther 2004; 308: 1021-1029
• 12 Ho KM, Power BM. Benefits and risks of furosemide in acute kidney injury. Anaesthesia 2010; 65: 283-293
• 13 Solomon R, Werner C, Mann D. et al Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. N Engl J Med 1994; 331: 1416-1420
• 14 Hager B, Betschart M, Krapf R. Effect of postoperative intravenous loop diuretic on renal function after major surgery. Schweiz Med Wochenschr 1996; 126: 666-673
• 15 Lassnigg A, Donner E, Grubhofer G. et al Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol 2000; 11: 97-104
• 16 Mahesh B, Yim B, Robson D. et al Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg 2008; 33: 370-376
• 17 Dussol B, Morange S, Loundoun A. et al A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol Dial Transplant 2006; 21: 2120-2126
• 18 Gu GQ, Lu R, Cui W. et al Low-dose furosemide administered with adequate hydration reduces contrast-induced nephropathy in patients undergoing coronary angiography. Cardiology 2013; 125: 69-73
• 19 Marenzi G, Ferrari C, Marana I. et al Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (Induced Diuresis With Matched Hydration Compared to Standard Hydration for Contrast Induced Nephropathy Prevention) trial. JACC Cardiovasc Interv 2012; 05: 90-97
• 20 Usmiani T, Andreis A, Budano C. et al AKIGUARD (Acute Kidney Injury GUARding Device) trial: in-hospital and one-year outcomes. J Cardiovasc Med (Hagerstown) 2016; 17: 530-537
• 21 Putzu A, Boscolo Berto M, Belletti A. et al Prevention of contrast-induced acute kidney injury by furosemide with matched hydration in patients undergoing interventional procedures: a systematic review and meta-analysis of randomized trials. JACC Cardiovasc Interv 2017; 10: 355-363
• 22 Bartorelli AL, Marenzi G. High urine output with matched hydration for CI-AKI prevention: “salus per aquam” (health through water). JACC Cardiovasc Interv 2017; 10: 364-366
• 23 Cantarovich F, Galli C, Benedetti L. et al High dose frusemide in established acute renal failure. Br Med J 1973; 04: 449-450
• 24 Ganeval D, Kleinknecht D, Gonzales-Duque LA. Letter: High-dose frusemide in renal failure. Br Med J 1974; 01: 244-245
• 25 Kleinknecht D, Ganeval D, Gonzalez-Duque LA. et al Furosemide in acute oliguric renal failure. A controlled trial. Nephron 1976; 17: 51-58
• 26 Shilliday IR, Quinn KJ, Allison ME. Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study. Nephrol Dial Transplant 1997; 12: 2592-2596
• 27 van der Voort PH, Boerma EC, Koopmans M. et al Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial. Crit Care Med 2009; 37: 533-538
• 28 Baek SM, Brown RS, Shoemaker WC. Early prediction of acute renal failure and recovery. II. Renal function response to furosemide. Ann Surg 1973; 178: 605-608
• 29 Chawla LS, Davison DL, Brasha-Mitchell E. et al Development and standardization of a furosemide stress test to predict the severity of acute kidney injury. Crit Care 2013; 17: R207
• 30 Matsuura R, Komaru Y, Miyamoto Y. et al Response to different furosemide doses predicts AKI progression in ICU patients with elevated plasma NGAL levels. Ann Intensive Care 2018; 08: 8
• 31 Koyner JL, Davison DL, Brasha-Mitchell E. et al Furosemide stress test and biomarkers for the prediction of AKI severity. J Am Soc Nephrol 2015; 26: 2023-2031
• 32 Lumlertgul N, Peerapornratana S, Trakarnvanich T. et al Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial). Crit Care 2018; 22: 101
• 33 Lameire N, Vanholder R, Van Biesen W. Loop diuretics for patients with acute renal failure: helpful or harmful?. JAMA 2002; 288: 2599-2601
• 34 Kidney Disease: Improving Global Outcomes. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 02: 1-138
• 35 Jo W, Koh ES, Chung S. Therapeutic roles of thiazides and loop diuretics in blood pressure control and renal protection against chronic kidney disease. Clin Hypertens 2023; 29: 14
• 36 De Nicola L, Minutolo R, Bellizzi V. et al Achievement of target blood pressure levels in chronic kidney disease: a salty question?. Am J Kidney Dis 2004; 43: 782-795
• 37 Seldin DW, Preisig PA, Alpern RJ. Regulation of proximal reabsorption by effective arterial blood volume. Semin Nephrol 1991; 11: 212-219
• 38 Cheung AK, Chang TI, Cushman WC. et al Kidney Int. 2021; 99: S1-SS87
• 39 Rose BD. Diuretics. Kidney Int 1991; 39: 336-352
• 40 Hropot M, Fowler N, Karlmark B. et al Tubular action of diuretics: distal effects on electrolyte transport and acidification. Kidney Int 1985; 28: 477-489
• 41 Velázquez H, Wright FS. Effects of diuretic drugs on Na, Cl, and K transport by rat renal distal tubule. Am J Physiol 1986; 250: F1013-F1023
• 42 Kunau Jr RT, Weller DR, Webb HL. Clarification of the site of action of chlorothiazide in the rat nephron. J Clin Invest 1975; 56: 401-407
• 43 Plotkin MD, Kaplan MR, Verlander JW. et al Localization of the thiazide sensitive Na-Cl cotransporter, rTSC1 in the rat kidney. Kidney Int 1996; 50: 174-183
• 44 Terada Y, Knepper MA. Thiazide-sensitive NaCl absorption in rat cortical collecting duct. Am J Physiol 1990; 259: F519-F528
• 45 Rouch AJ, Chen L, Troutman SL. et al Na + transport in isolated rat CCD: effects of bradykinin, ANP, clonidine, and hydrochlorothiazide. Am J Physiol 1991; 260: F86-F95
• 46 Leviel F, Hübner CA, Houillier P. et al The Na + -dependent chloride-bicarbonate exchanger SLC4A8 mediates an electroneutral Na + reabsorption process in the renal cortical collecting ducts of mice. J Clin Invest 2010; 120: 1627-1635
• 47 Sinha AD, Agarwal R. Clinical pharmacology of antihypertensive therapy for the treatment of hypertension in CKD. Clin J Am Soc Nephrol 2019; 14: 757-764
• 48 Blowey DL. Diuretics in the treatment of hypertension. Pediatr Nephrol 2016; 31: 2223-2233
• 49 Brater DC. Pharmacology of diuretics. Am J Med Sci 2000; 319: 38-50
• 50 Stanton BA, Kaissling B. Regulation of renal ion transport and cell growth by sodium. Am J Physiol 1989; 257: F1-F10
• 51 Garg LC, Narang N. Effects of hydrochlorothiazide on Na-K-ATPase activity along the rat nephron. Kidney Int 1987; 31: 918-922
• 52 Reubi FC, Cottier PT. Effects of reduced glomerular filtration rate on responsiveness to chlorothiazide and mercurial diuretics. Circulation 1961; 23: 200-210
• 53 Chobanian AV, Bakris GL, Black HR. et al The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560-2572
• 54 Kidney Disease Outcomes Quality Initiative (K/DOQI) K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004; 43: S1-S290
• 55 Mancia G, Kreutz R, Brunström M. et al 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41: 1874-2071
• 56 Agarwal R, Sinha AD, Cramer AE. et al Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med 2021; 385: 2507-2519
• 57 Agarwal R, Sinha AD, Pappas MK. et al Chlorthalidone for poorly controlled hypertension in chronic kidney disease: an interventional pilot study. Am J Nephrol 2014; 39: 171-182
• 58 Bennett WM, McDonald WJ, Kuehnel E. et al Do diuretics have antihypertensive properties independent of natriuresis?. Clin Pharmacol Ther 1977; 22: 499-504
• 59 Vasavada N, Saha C, Agarwal R. A double-blind randomized crossover trial of two loop diuretics in chronic kidney disease. Kidney Int 2003; 64: 632-640
• 60 Dussol B, Moussi-Frances J, Morange S. et al A pilot study comparing furosemide and hydrochlorothiazide in patients with hypertension and stage 4 or 5 chronic kidney disease. J Clin Hypertens (Greenwich) 2012; 14: 32-37
• 61 Hayashi SY, Seeberger A, Lind B. et al Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients: a tissue Doppler study. Nephrol Dial Transplant 2008; 23: 1355-1361
• 62 Duarte JD, Cooper-DeHoff RM. Mechanisms for blood pressure lowering and metabolic effects of thiazide and thiazide-like diuretics. Expert Rev Cardiovasc Ther 2010; 08: 793-802
• 63 Solomon RJ, Stillman N, Weinberg MS. Thiazide induced hypotension: the role of plasma volume reduction and the urinary kallikrein system. Adv Exp Med Biol 1986; 198 Pt B 243-251
• 64 Huang X, Dorhout Mees E, Vos P. et al Everything we always wanted to know about furosemide but were afraid to ask. Am J Physiol Renal Physiol 2016; 310: F958-F971
• 65 Castrop H, Schnermann J. Isoforms of renal Na-K-2Cl cotransporter NKCC2: expression and functional significance. Am J Physiol Renal Physiol 2008; 295: F859-F866
• 66 Schnermann J, Briggs JP. Tubular control of renin synthesis and secretion. Pflugers Arch 2013; 465: 39-51
• 67 Abraham B, Megaly M, Sous M. et al Meta-analysis comparing torsemide versus furosemide in patients with heart failure. Am J Cardiol 2020; 125: 92-99
• 68 Lee H, Kwon SH, Jeon JS. et al Association between blood pressure and the risk of chronic kidney disease in treatment-naïve hypertensive patients. Kidney Res Clin Pract 2022; 41: 31-42
• 69 Trujillo H, Caravaca-Fontán F, Caro J. et al The forgotten antiproteinuric properties of diuretics. Am J Nephrol 2021; 52: 435-449
• 70 Herrington WG, Staplin N, Wanner C. et al Empagliflozin in patients with chronic kidney disease. N Engl J Med 2023; 388: 117-127
• 71 Wheeler DC, Stefánsson BV, Jongs N. et al Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol 2021; 09: 22-31
• 72 Buter H, Hemmelder MH, Navis G. et al The blunting of the antiproteinuric efficacy of ACE inhibition by high sodium intake can be restored by hydrochlorothiazide. Nephrol Dial Transplant 1998; 13: 1682-1685
• 73 Uzu T, Harada T, Namba T. et al Thiazide diuretics enhance nocturnal blood pressure fall and reduce proteinuria in immunoglobulin A nephropathy treated with angiotensin II modulators. J Hypertens 2005; 23: 861-865
• 74 Vogt L, Waanders F, Boomsma F. et al Effects of dietary sodium and hydrochlorothiazide on the antiproteinuric efficacy of losartan. J Am Soc Nephrol 2008; 19: 999-1007
• 75 Kwakernaak AJ, Krikken JA, Binnenmars SH. et al Effects of sodium restriction and hydrochlorothiazide on RAAS blockade efficacy in diabetic nephropathy: a randomised clinical trial. Lancet Diabetes Endocrinol 2014; 02: 385-395
• 76 Hoshino T, Ookawara S, Miyazawa H. et al Renoprotective effects of thiazides combined with loop diuretics in patients with type 2 diabetic kidney disease. Clin Exp Nephrol 2015; 19: 247-253
• 77 Marre M, Puig JG, Kokot F. et al Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR Study. J Hypertens 2004; 22: 1613-1622
• 78 Esnault VL, Ekhlas A, Delcroix C. et al Diuretic and enhanced sodium restriction results in improved antiproteinuric response to RAS blocking agents. J Am Soc Nephrol 2005; 16: 474-481
• 79 Esnault VL, Ekhlas A, Nguyen JM. et al Diuretic uptitration with half dose combined ACEI + ARB better decreases proteinuria than combined ACEI + ARB uptitration. Nephrol Dial Transplant 2010; 25: 2218-2224
• 80 Polychronopoulou E, Wuerzner G, Burnier M. How do I manage hypertension in patients with advanced chronic kidney disease not on dialysis? Perspectives from Clinical Practice. Vasc Health Risk Manag 2021; 17: 1-11
• 81 Hansson L, Lindholm LH, Niskanen L. et al Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999; 353: 611-616
• 82 Schork A, Bohnert BN, Heyne N. et al Overhydration measured by bioimpedance spectroscopy and urinary serine protease activity are risk factors for progression of chronic kidney disease. Kidney Blood Press Res 2020; 45: 955-968
• 83 Hawkins RG, Houston MC. Is population-wide diuretic use directly associated with the incidence of end-stage renal disease in the United States? A hypothesis. Am J Hypertens 2005; 18: 744-749
• 84 Khan YH, Sarriff A, Adnan AS. et al Outcomes of diuretic use in pre-dialysis CKD patients with moderate renal deterioration attending tertiary care referral center. Clin Exp Nephrol 2017; 21: 1011-1023
• 85 Khan YH, Sarriff A, Adnan AS. et al Progression and outcomes of non-dialysis dependent chronic kidney disease patients: A single center longitudinal follow-up study. Nephrology (Carlton) 2017; 22: 25-34
• 86 Rahman M, Pressel S, Davis BR. et al Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 2005; 165: 936-946
• 87 Fitzpatrick JK, Yang J, Ambrosy AP. et al Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study. BMJ Open 2022; 12: e048755