Comparison of the clinical and metabolic effects of hydrochlorothiazide and xipamide in resistance edematous syndrome in hospitalized patients with heart failure and concomitant renal dysfunction

Abstract

The aim – to compare the diuretic effect and tolerability of xipamide and hydrochlorothiazide as second-line diuretics in hospitalized patients with decompensation heart failure (HF), concomitant renal dysfunction and diuretic resistance.
Materials and methods. 50 patients with decompensation HF and diuretic resistance were included in the open comparative randomized parallel group study. These patients had refractory to intravenous loop diuretic therapy (LD) (daily diuresis <2000 ml with a daily dose of furosemide 320 mg), and were randomized into 2 equivalent groups, who were prescribed hydrochlorothiazide (HCT) (n=25) and xipamide (n=25). The groups were comparable in age, gender, structure of the main comorbid conditions and basic treatment. Patients with estimated glomerular filtration rate > 60 and < 15 ml/min/1.73 m2 were excluded. 
Results. The study groups were no significant differences in terms of basic demographic, clinical and instrumental parameters and the structure of the treatment; almost half of the patients had generalized edematous syndrome. At the time of randomization, there were no statistically significant differences in daily urine output between patients in both groups, but after randomization, significantly higher values of its output were observed in the xipamide group. This was also consistent with greater weight loss and lower dyspnea severity on the Likert scale on day 5 of treatment in patients receiving xipamide compared with HCT. Compared with xipamide, HCT was associated with increased uric acid levels, worsening of glomerular filtration, and significantly lower plasma K+ levels on the 5th day of treatment. 
Conclusions. The addition of the non-thiazide sulfonamide diuretic xipamide or HCT to an intravenous loop diuretic in resistance edematous syndrome in patients with decompensation HF and renal dysfunction has unidirectional positive effects in the form of an increase in daily diuresis, a decrease in body weight and a decrease in dyspnea on a Likert scale. Compared with HCT, the use of xipamide is associated with significantly higher values of daily diuresis, greater total weight loss and more significant decrease in dyspnea on a Likert scale. At the same time, unlike xipamide, the use of HCT is associated with an increase in uric acid levels, deterioration of nitrogen-excreting renal function, and a significant decrease in plasma K+ levels. These data provide grounds for preliminary consideration of xipamide as a more effective and potentially safer second-line diuretic in hospitalized patients with HF, concomitant renal dysfunction, and resistance to intravenous LD therapy.