A prospective observational study on loop diuretic utilization in a tertiary care hospital setting
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20250358Keywords:
Loop diuretics, Furosemide, Adverse drug reactions, Prescription patterns, Economic cost, Therapeutic outcomesAbstract
Background: Loop diuretics are essential for managing fluid overload in conditions like heart failure and chronic kidney disease. However, data on their utilization and adverse outcomes in resource-limited settings are scarce. To evaluate utilization patterns, adverse drug reactions (ADRs), and outcomes of loop diuretic therapy in a tertiary care hospital.
Methods: A prospective observational study was conducted on 100 inpatients from January 2023 to October 2023. Data on demographics, clinical indications, ADRs, and prescription patterns were analyzed.
Results: Furosemide was most prescribed (70%), followed by torsemide (20%) and bumetanide (10%). Main indications included congestive heart failure (40%), hypertension (24%), and chronic kidney disease (20%). Common ADRs were hypokalemia (16%), hypotension (10%), and dehydration (6%). Symptomatic improvement was noted in 70% of cases, with 20% showing no change and 10% worsening. Economic costs exceeded ₹1,000/month for 30% of patients, despite high medication adherence (80%).
Conclusions: Furosemide remains the most used diuretic, but ADRs and economic burdens highlight the need for regular monitoring and cost-effective strategies. Personalized therapy can optimize outcomes, and further multicenter studies are required for broader insights.
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References
Bhattacharyya K, Tiwaskar M, Datta A, Chandani AL, Agrawal SK, Abdullakutty J, et al. Torsemide in the management of essential hypertension. The J of the Association of Physicians of India. 2024;72(9):35-7.
Oh SW, Han SY. Loop diuretics in clinical practice, 2015;13(1):17-21. DOI: https://doi.org/10.5049/EBP.2015.13.1.17
Crutel V, Lambert E, Penelaud PF, Albarrán Severo C, Fuentes J, Rosier A, et al.Hervás A, Marret S, Oliveira G, Parellada M, Kyaga S. Bumetanide oral liquid formulation for the treatment of children and adolescents with autism spectrum disorder: Design of two phase III studies (SIGN Trials). J Aut Dev Disord. 2021;51:2959-72. DOI: https://doi.org/10.1007/s10803-020-04709-8
Brater DC. Clinical pharmacology of loop diuretics. Drugs. 1991;41(3):14-22. DOI: https://doi.org/10.2165/00003495-199100413-00004
Boles Ponto LL, Schoenwald RD. Furosemide (Frusemide) a pharmacokinetic/pharmacodynamic review (part I). Clinical Pharmacokinetics. 1990;18:381-408. DOI: https://doi.org/10.2165/00003088-199018050-00004
Friedel HA, Buckley MM. Torasemide. Drugs. 1991;41(1):81-103. DOI: https://doi.org/10.2165/00003495-199141010-00008
Ward A, Heel RC. Bumetanide: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic use. Drugs. 1984;28:426-64. DOI: https://doi.org/10.2165/00003495-198428050-00003
Molnar J, Somberg JC. The clinical pharmacology of ethacrynic acid. Am J of Therap. 2009;16(1):86-92. DOI: https://doi.org/10.1097/MJT.0b013e318195e460
Pius R, Odukudu GO, Olorundare I. A narrative review on the efficacy and safety of loop diuretics in patients with heart failure with reduced ejection fraction and preserved ejection fraction. Cureus. 2023;15(9):45794. DOI: https://doi.org/10.7759/cureus.45794
Patschan D, patschan S, Buschmann I, Ritter O Kidney Blood Press Res. 2019;44(4):457-64. DOI: https://doi.org/10.1159/000501315
Gheorghiade M, Pang PS. Acute heart failure syndromes. N Engl J Med. 2013;368(12):1151-9.
Felker GM, Ellison DH, Mullens W. Diuretic therapy for patients with heart failure. Circulation. 2011;123(24):2752-61.
Mentz RJ, Raj DS, Schulte PJ. Torsemide versus furosemide in heart failure patients. J Am Coll Cardiol. 2016;67(10):1197-205.
Mishra S, Kumar S. Prescription trends of diuretics in India. Indian J Pharmacol. 2018;50(2):101-7.
Butler J, Marti CN, Teerlink JR. Heart failure therapies and outcomes. Lancet. 2014;383(31):1125-33.
Ronco C, Bellomo R, Kellum JA. Loop diuretics in critically ill patients. Nat Rev Nephrol. 2014;10(12):743-55.
Whelton PK, Carey RM, Aronow WS. Guidelines for the prevention, detection, evaluation, and management of high blood pressure. Hypertension. 2018;71(6):13-5.
Ellison DH, Felker GM. Diuretic-related electrolyte disorders. Kidney Int. 2010;78(4):342-52.
Sterns RH, Silver SM. Electrolyte imbalances due to loop diuretics. Am J Med. 2013;126(2):97-104.
Palmer BF, Clegg DJ. Strategies to manage diuretic complications. Clin J Am Soc Nephrol. 2019;14(5):665-75.
Vaduganathan M, Greene SJ, Butler J. Diuretic use in advanced heart failure. Eur Heart J. 2019;40(40):3177-85.
Heerspink HJL, Stefánsson BV, Correa-Rotter R. Diuretics and kidney disease outcomes. Kidney Int. 2018;94(1):12-23.
Maaten JM, Valente MAE, Damman K. Diuretic resistance in acute heart failure. Eur J Heart Fail. 2015;17(10):1114-22.
Hoorn EJ, Ellison DH. Clinical approaches to diuretic resistance. J Am Soc Nephrol. 2011;22(4):720-3.
Desai AS, Stevenson LW. Adherence to diuretic therapy. JAMA. 2012;308(15):1592-8. DOI: https://doi.org/10.1001/2012.jama.11065