J Clin Nephrol Kidney Dis | Volume 4, Issue 1 | Case Report | Open Access

Diuretic Dosing in Heart Failure and Chronic Kidney Disease

Shivam Joshi^1* and Michael Chaknos²

¹Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, USA
²Perelman School of Medicine, University of Pennsylvania, USA

^*Correspondance to: Shivam Joshi 

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Abstract

Diuretics are commonly used in patients with heart failure, chronic kidney disease, or both for volume management. However, their effectiveness is dependent upon their proper utilization, like any other medication. In chronic kidney disease, higher doses of diuretics are needed to reach the threshold to induce diuresis. Diuretics with especially short-half lives, like furosemide, induce a state of salt retention for the remainder of the day, an entity known as post-diuretic salt retention, and usually require at least twice daily dosing. Furosemide is also noteworthy for its widely variable bioavailability in its oral formulation. Intravenous furosemide and other oral loop diuretics have more reliable bioavailability. For patients exposed to loop diuretics chronically, a phenomenon known as “braking” which may occur in reduce diuresis but is overcome by administering thiazide diuretics before the loop diuretic.

Keywords:

Diuretics; Dosing; Heart failure; Chronic kidney disease

Citation:

Joshi S, Chaknos M. Diuretic Dosing in Heart Failure and Chronic Kidney Disease. J Clin Nephrol Kidney Dis. 2019; 4(1): 1019.