#4949 COMBINED ORAL DIURETICS: A BETTER ALTERNATIVE FOR NEPHROTIC EDEMA THAN INTRAVENOUS FUROSEMIDE?

Abstract Background and Aims Edema is a serious complication of nephrotic syndrome the main reason why patients usually address to doctor. There no guideline on managing edema. Besides non pharmacological interventions such as sodium water restrictions, most doctors would choose high doses intravenous furosemide first option, but still many fail properly decrease their volume overload, they become diuretic resistant. Amiloride, an ENaC mediated diuretic, optimistic management especially when used with other diuretics. The aim present study was assess inferiority combined oral diuretics fixed combination hydrochlorothiazide/amiloride in resistant Method We conducted prospective randomized trial 22 Based computer-generated randomization we assigned receive either (40 mg bolus then continuous administration 5 mg/h) or mg/day) (50/5 mg/day). Clinical laboratory measurements were performed daily, for five days (body weight, urinary output, blood pressure hydration status by bioimpedance twice, creatinine, urea, albumin, hematocrit, Na, K, Ca, Mg, bicarbonate, pH). primary outcome weight change from baseline day 5. Secondary outcomes safety (low pressure, severe dyselectrolytemia, acute kidney injury aggravated hypervolemia). Results equally distributed between two groups. Mean age 47,77±15,97 (54,5% females 45,5% males). Half had membranous nephropathy (45,5%), followed minimal disease (22,7%) lupus nephritis (9,1%). 86,4% episode mean significantly larger magnitude group compared (-7,97±2,83 [SD] vs -4,5±2,6 kg; p = 0,018). Although increase 24-hour urine excretion higher group, this increment not statistically significant different (26,79±33,48 16,04±42,81 mmol/24 h [SD]; 0,5). values changes systolic diastolic BP, volume, measured A total could be through, 4 (two experienced low blood, one patient response iv suffered insomnia due pump) hyperkalemia (>6,5 mmol/l). Conclusion Combined furosemide, amiloride hydrochlorothiazide more effective safer than treatment refractory These results make promising further trials sample sizes longer follow-up are needed regard.