Kop miqtarda suduk mangduridighan dora ishlitish xeterlik

Yurek ajizliship balinistta yitip qalghan bimarlarni dawalashta,
doxturlar adette yurekni kuchlenduridighan dorilarni ishlitish bilen
birge kop miqtarda suduk mangduridighan dora ishlitidighan bolup,
yiqinqi tetqiqat netijisige asaslanghanda yuriki ajiz bimarlargha
kop miqtarda suduk mangghuzidighan dora ishletkende, bimarning olup
kitish ihtimali iship kitidiken.

High-dose diuretics raise mortality in heart failure

Wednesday, July 19, 2006

By Martha Kerr

NEW YORK (Reuters Health) - As the dosage of loop diuretics
increases in patients with advanced heart failure, the risk of death
also increases, according to findings of a study conducted at the
University of California at Los Angeles.

"This is the very first study to look specifically at the
relationship between various doses of loop diuretics and mortality,"
lead investigator Dr. Gregg C. Fonarow told Reuters Health.

"When studying whether a medication may be contributing to adverse
clinical outcomes in a patient population," he noted, demonstrating
whether or not the relationship is dose dependent is critical."

Diuretics are a class of commonly prescribed drugs that are used to
treat heart disease and other illnesses. The drugs stimulate the
kidneys to remove more water from the body, which is then passed
through the urine. Loop diuretics are a strong type of diuretics.

Fonarow and his colleagues studied a group of 1,354 patients with
advanced heart failure receiving treatment at their institution
between 1985 and 2004. The average age was 53 years, 76 percent were
male and the heart's ability to pump blood was reduced to an average
of 24 percent.

The investigators divided the group into four sections, according to
loop diuretic dosage. The four groups were similar in terms of age,
gender, body mass index, cause of heart failure, history of high
blood pressure and previous use of the diuretic spironolactone. The
highest dose group had, on average, the lowest ability to pump
blood, a well as lower levels of sodium and hemoglobin levels and
higher levels of biomarkers of kidney disease.

As reported in the June 15th issue of the American Journal of
Cardiology, there was a decrease in survival with increasing dose of
loop diuretic. Survival estimates at 2 years were 83 percent with
the lowest dose, 81 percent in the second group, 68 percent in the
third group and 53 percent in the highest group.

Even after the data were adjusted to remove the effects factors that
could also increase mortality -- including age, strength of other
drug treatments, kidney function, smoking history and blood
pressure -- diuretic dosage remained an independent predictor of
mortality. For the high-dose group compared with the low-dose group,
the mortality risk was increased by four-fold, the team reports.

Fonarow offered an explanation for the link between loop diuretics
and mortality in heart failure. Loop diuretics, especially when
given at higher doses, activate a part of the nervous system known
to increase the risk of death in heart failure patients. Loop
diuretics, especially at higher doses, can also contribute to
worsened kidney function and electrolyte abnormalities.

Nonetheless, "loop diuretics currently are one of the only therapies
for heart failure patients for the treatment of congestion along
with dietary sodium restriction," Fonarow acknowledged.

He recommends that physician use loop diuretics at the lowest dose
possible dose to relieve congestion. Some physicians (in the study)
favored using higher than necessary doses of loop diuretics to keep
their heart failure patients' free of fluid. 'This study suggests
that this practice should be avoided."

SOURCE: The American Journal of Cardiology, June 15, 2006.