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Efficacy of sequential nephron blockade with intravenous chlorothiazide to promote diuresis in cardiac intensive care infants

Published online by Cambridge University Press:  11 November 2016

Brady S. Moffett ,
Rocky Tsang ,
Curt Kennedy ,
Ron A. Bronicki ,
Ayse Akcan-Arikan  and
Paul A. Checchia
Brady S. Moffett*
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Rocky Tsang
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Curt Kennedy
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Ron A. Bronicki
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Ayse Akcan-Arikan
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Paul A. Checchia
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: B. S. Moffett, PharmD, MPH, Department of Pharmacy, Texas Children’s Hospital, 6621 Fannin Street, Suite WB1120, Houston, TX 77030, United States of America. Tel: +832 824 6087; Fax: +832 825 5261; E-mail: bsmoffet@texaschildrens.org
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Abstract

Background

Sequential nephron blockade using intravenous chlorothiazide is often used to enhance urine output in patients with inadequate response to loop diuretics. A few data exist to support this practice in critically ill infants.

Methods

We included 100 consecutive patients <1 year of age who were administered intravenous chlorothiazide while receiving furosemide therapy in the cardiac ICU in our study. The primary end point was change in urine output 24 hours after chlorothiazide administration, and patients were considered to be responders if an increase in urine output of 0.5 ml/kg/hour was documented. Data on demographic, clinical, fluid intake/output, and furosemide and chlorothiazide dosing were collected. Multivariable regression analyses were performed to determine variables significant for increase in urine output after chlorothiazide administration.

Results

The study population was 48% male, with a mean weight of 4.9±1.8 kg, and 69% had undergone previous cardiovascular surgery. Intravenous chlorothiazide was initiated at 89 days (interquartile range 20–127 days) of life at a dose of 4.6±2.7 mg/kg/day (maximum 12 mg/kg/day). Baseline estimated creatinine clearance was 83±42 ml/minute/1.73 m2. Furosemide dose before chlorothiazide administration was 2.8±1.4 mg/kg/day and 3.3±1.5 mg/kg/day after administration. A total of 43% of patients were categorised as responders, and increase in furosemide dose was the only variable significant for increase in urine output on multivariable analysis (p<0.05). No graphical trends were noted for change in urine output and dose of chlorothiazide.

Conclusions

Sequential nephron blockade with intravenous chlorothiazide was not consistently associated with improved urine output in critically ill infants.

Keywords

Diuretic resistancechlorothiazideloop diureticsfurosemidepaediatricsintensive care
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1104 - 1109
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Copyright
© Cambridge University Press 2016 

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