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

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Background: The main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion, it is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits when compared with stepped furosemide (SF). Methods: We conducted a double-blind randomized clinical trial in CRS1 consecutive patients, we randomized in a 1:1 fashion to SF group or CD. The SF group received a continuous infusion of furosemide 100mg during the first day, with daily incremental doses to 200mg, 300mg and 400mg during the second, third and fourth day, respectively. The CD group consist in the combination of diuretics trying to block different tubular segments, including 4 consecutive days of oral chlortalidone 50mg, spironolactone 50mg and infusion of furosemide 100mg. The objectives were asses renal function recovery, and variables associated with vascular decongestion. Results: During July 2017 to February 2020, 80 patients were randomized, 40 to the SF and 40 to the CD group, both groups were similar at baseline and had several very high-risk features. Mean age was 59 ± 14.5 years, male gender was 37 (46.2%), the median follow up was 182 days, Primary endpoint occurred in 20% in the SF group and in 15.2% in the DC group (p= 0.49), all secondary and exploratory endpoints were similar between groups with non-significant differences. Adverse events occurred frequently (85%) with no differences between groups (p = 0.53). Conclusions: In patients with SCR-1 and high risk of resistance to diuretics, the strategy of CD compared to SF, offers the same frequency of renal recovery, diuresis, vascular decongestion and adverse events, so it can be considered as an alternative, especially in cases where it is not considered advisable to increase furosemide.

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