Which loop diuretic to give preference to: review of evidence-based medicine data

April 14, 2023
1165
Resume

Diuretics belong to the first-line therapy of arterial hypertension, heart failure, edema, maintenance of target blood pressure in chronic kidney disease, and reduction of edema in nephrotic syndrome. Almost each of the pathologies listed above is the basis for the use of loop diuretics. Torasemide has a strong dose-dependent effect, a long half-life, a combined hepatic-renal excretion, and a minor effect on potassium excretion, and it is characterized by a good safety profile and good tolerability. The results of trials, systematic reviews, and meta-analyses confidently prove the clinical benefits of using torasemide: improvement of functional class according to NYHA, reduction of the probability of repeated hospitalizations due to deterioration of the course of heart failure, potential reduction of mortality. Such pharmacological features and a reliable evidence base of effectiveness and safety make torasemide a loop diuretic of choice in the management of patients with heart failure and edema syndrome.

References

  • 1. Williams B., Mancia G., Spiering W. et al. (2019) 2018 ESC/ESH Guidelines for the management of arterial hypertension. Kardiol Pol., 77(2): 71–159. doi: 10.5603/KP.2019.0018.
  • 2. McDonagh T.A., Metra M., Adamo M. et al. (2022) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Rev. Esp. Cardiol. (Engl. Ed.)., 75(6): 523. English, Spanish. doi: 10.1016/j.rec.2022.05.005.
  • 3. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group (2021) KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int., 99(3S): S1–S87. doi: 10.1016/j.kint.2020.11.003.
  • 4. Rovin B.H., Adler S.G., Barratt J. et al. (2021) Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney Int., 100(4): 753–779.
  • 5. Bikdeli B., Strait K.M., Dharmarajan K. et al. (2013) Dominance of furosemide for loop diuretic therapy in heart failure: time to revisit the alternatives? J. Am. Coll. Cardiol., 61(14): 1549–1550. doi: 10.1016/j.jacc.2012.12.043.
  • 6. Escudero V.J., Mercadal J., Molina-Andu´jar A. et al. (2022) New Insights Into Diuretic Use to Treat Congestion in the ICU: Beyond Furosemide. Front. Nephrol., 2: 879766.
  • 7. Peters A.E., Mentz R.J., DeWald T.A. et al. (2022) An evaluation of torsemide in patients with heart failure and renal disease. Expert. Rev. Cardiovasc. Ther., 20(1): 5–11.
  • 8. Buggey J., Mentz R.J., Pitt B. et al. (2015) A reappraisal of loop diuretic choice in heart failure patients. Am. Heart J., 169(3): 323–333. doi: 10.1016/j.ahj.2014.12.009.
  • 9. Wargo K.A., Banta W.M. (2009) A comprehensive review of the loop diuretics: should furosemide be first line? Ann. Pharmacother., 43(11): 1836–1847. doi: 10.1345/aph.1M177.
  • 10. López B., González A., Hermida N. et al. (2008) Myocardial fibrosis in chronic kidney disease: potential benefits of torasemide. Kidney Int. Suppl., (111): S19–S23.
  • 11. Trujillo H., Caravaca-Fontán F., Caro J. et al. (2021)The Forgotten Antiproteinuric Properties of Diuretics. Am. J. Nephrol., 52(6): 435–449. doi: 10.1159/000517020.
  • 12. Müller K., Gamba G., Jaquet F. et al. (2003) Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV — efficacy and quality of life. Eur. J. Heart Fail., 5(6): 793–801. doi: 10.1016/s1388-9842(03)00150-8.
  • 13. Balsam P., Ozierański K., Marchel M. et al. (2019) Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial. Cardiol. J., 26(6): 661–668. doi: 10.5603/CJ.a2019.0114.
  • 14. Cosín J., Díez J.; TORIC investigators (2002) Torasemide in chronic heart failure: results of the TORIC study. Eur. J. Heart Fail., 4: 507–513. doi: 10.1016/s1388-9842(02)00122-8.
  • 15. Mentz R.J., Anstrom K.J., Eisenstein E. et al. (2023) Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. JAMA, 329(3): 214–223. doi: 10.1001/jama.2022.23924.
  • 16. Sherif N.A., Morra M.E., Thanh L. et al. (2020) Torasemide versus furosemide in treatment of heart failure: A systematic review and meta-analysis of randomized controlled trials. J. Eval. Clin. Pract., 26(3): 842–851. doi: 10.1111/jep.13261.
  • 17. Eid P.S., Ibrahim D.A., Zayan A. et al. (2021) Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials. Heart Fail. Rev., 26(1): 127–136.
  • 18. Zhao X., Ren Y., Li H. et al. (2019) The Effect of Diuretics on Patients with Heart Failure: A Network Meta-Analysis: Diuretics Effect on Heart Failure Patients. J. Pharm. Pharm. Sci., 22(1): 270–280. doi: 10.18433/jpps30146.
  • 19. Miles J.A., Hanumanthu B.K., Patel K. et al. (2019) Torsemide versus furosemide and intermediate-term outcomes in patients with heart failure: an updated meta-analysis. J. Cardiovasc. Med. (Hagerstown), 20(6): 379–388. doi: 10.2459/JCM.0000000000000794.
  • 20. Abraham B., Megaly M., Sous M. et al. (2020) Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure. Am. J. Cardiol., 125(1): 92–99.