Abstract: TH-PO583
Effects of Diuretics Furosemide and Hydrochlorothiazide on CKD-MDB: A Prospective Randomized Study
Session Information
- Bone and Mineral Metabolism: Bone Disease
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 402 Bone and Mineral Metabolism: Clinical
Authors
- Vasco, Raquel F. V., Hospital das Clinicas HCFMUSP, São Paulo, Sao Paulo, Brazil
- Moyses, Rosa M.A., Hospital das Clinicas HCFMUSP, São Paulo, Sao Paulo, Brazil
- Elias, Rosilene M., Hospital das Clinicas HCFMUSP, São Paulo, Sao Paulo, Brazil
Background
Diuretics are often prescribed to patients with CKD to control fluid overload and hypertension. Diuretics may affect CKD-MBD since thiazides are associated with reduced calciuria, reduction/maintenance of PTH levels and increased bone density while loop diuretics have the opposite effect. These effects are still debatable and not fully elucidated in patients with CKD. Objective: To evaluate the effects of furosemide (FURO) and hydrochlorothiazide (HYDRO) on CKD-BMD in patients with stage 3 CKD in a regular follow-up.
Methods
This was a RCT comparing HYDRO (25mg/day) and FURO (40mg/day) on urinary and biochemical variables including parathyroid hormone (PTH), alkaline phosphatase (AP), calcium (Ca), CTx and P1NP. After a washout period, patients were randomized to either the HYDRO or FURO group and followed for 1 year, by the same observer, blinded to randomization. Bone effects were also evaluated by Dual X-ray absorptiometry (DXA).
Results
40 patients with a median of 62 years were included, 20 were randomized to each group, which presented similar characteristics after randomization (for age, gender, eGFR, weight, PTH, Ca, 25(OH)Vitamin-D, and AP). There was a reduction of urinary Ca in the HYDRO group and an increase in the FURO group (p=0.02), in addition to a tendency of a higher total serum Ca in the HYDRO group (p=0.06). There was no difference in PTH and 25(OH)Vitamin-D levels, albeit there was an annual percentage increase of 1,25 (OH)2ViTD in the FURO group (12.7 ± 32%) and a reduction in the HYDRO group (-13.6 ± 21%), p=0.048. CTX, P1NP, and AP increased in the FURO group and reduced in the HYDRO group (all p<0.05). No significant difference was found in the percentage change of bone density measured by DXA, only a tendency to greater loss in the proximal 1/3 of the distal radius, more pronounced in the FURO group (p=0.06).
Conclusion
Furosemide and hydrochlorothiazide had opposite effects on the CKD-MBD in a 1-year follow-up study. Furosemide seems to be associated with an increase and hydrochlorothiazide with reduced bone remodeling, a fact not evidenced by PTH change. Whether PTH would change in more advanced CKD or in a bigger sample size warrants further investigation.