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

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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 high-risk 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 2.: Primary endpoint Renal function recovery (sCr return to baseline value) in 80 patients with cardiorenal type 1 syndrome according to allocation groups.

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