Effect of furosemide on left ventricular mass in non-dialysis chronic kidney disease patients: a randomized controlled trial.
BACKGROUND
In chronic kidney disease (CKD), loop diuretics correct volume-dependent hypertension, but their effect on left ventricular mass index (LVMI) is unknown.


METHODS
Forty hypertensive CKD patients (estimated creatinine clearance 60-15 mL/min/1.73 m²), treated with renin-angiotensin system (RAS) inhibitors, were randomized to receive furosemide or non-diuretic antihypertensive treatment (control group). Office blood pressure (BP) < 130/80 mmHg was pursued in both groups. Primary end point was the reduction of LVMI after 52 weeks. Secondary aims were to verify safety related to furosemide treatment and its effects on ambulatory and clinic BP and body fluid volumes.


RESULTS
Office BP similarly declined in the furosemide group (from 161 ± 14/80 ± 10 to 139 ± 14/74 ± 8 mmHg) and in controls (from 159 ± 16/81 ± 10 to 137 ± 16/75 ± 10 mmHg). We detected a greater reduction (P = 0.013) of LVMI in patients receiving furosemide (-7.9, IQR from -15.8 to -1.4 g/h(2.7)) than in controls (0.0, IQR from -6.2 to + 9.5 g/h(2.7), P = 0.013). Bio-impedance analysis-derived extracellular water (ECW) significantly decreased in furosemide-treated patients (from 18.7 ± 3.9 to 17.7 ± 3.3 L) while remained unchanged in the control group (from 19.5 ± 2.2 to 19.6 ± 1.9 L). Absolute change of LVMI correlated with changes of ECW in furosemide-treated patients (r = 0.458, P = 0.042) but not in controls. In the furosemide group, no patient experienced side effects requiring drug withdrawal.


CONCLUSIONS
In hypertensive CKD patients treated with RAS inhibitors, add-on furosemide efficaciously reduces LVMI independently from BP changes. The effect is possibly mediated by better control of volume expansion.
Zamboli
Pasquale
P
Division of Nephrology, Second University of Naples, Naples, Italy. roberto.minutolo@unina2.it
De Nicola
Luca
L
Minutolo
Roberto
R
Chiodini
Paolo
P
Crivaro
Marina
M
Tassinario
Sergio
S
Bellizzi
Vincenzo
V
Conte
Giuseppe
G
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D004452:Echocardiography; D005260:Female; D005665:Furosemide / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000209:etiology; D007677:Kidney Function Tests; D008297:Male; D011379:Prognosis
D000959:Antihypertensive Agents; D005665:Furosemide; D003404:Creatinine