Effect of furosemide on left ventricular mass in non-dialysis chronic kidney disease patients: a randomized controlled trial

Background. In chronic kidney disease (CKD), loop diuretics correct volume-dependent hypertension, but their effect on left ventricular mass index (LVMI) is unknown. Methods. Forty hypertensive CKD patients (estimated creatinine clearance 60-15 mL/min/1.73 m(2)), treated with renin-angiotensin system (RAS) inhibitors, were randomized to receive furosemide or non-diuretic antihypertensive treatment (control group). Office blood pressure (BP) < 130/80 mmHg was pursued in both groups. Primary end point was the reduction of LVMI after 52 weeks. Secondary aims were to verify safety related to furosemide treatment and its effects on ambulatory and clinic BP and body fluid volumes. Results. Office BP similarly declined in the furosemide group (from 161 +/- 14/80 +/- 10 to 139 +/- 14/74 +/- 8 mmHg) and in controls (from 159 +/- 16/81 +/- 10 to 137 +/- 16/75 +/- 10 mmHg). We detected a greater reduction (P = 0.013) of LVMI in patients receiving furosemide (-7.9, IQR from -15.8 to -1.4 g/h(2.7)) than in controls (0.0, IQR from -6.2 to + 9.5 g/h(2.7), P = 0.013). Bio-impedance analysis-derived extra-cellular water (ECW) significantly decreased in furosemide-treated patients (from 18.7 +/- 3.9 to 17.7 +/- 3.3 L) while remained unchanged in the control group (from 19.5 +/- 2.2 to 19.6 +/- 1.9 L). Absolute change of LVMI correlated with changes of ECW in furosemide-treated patients (r = 0.458, P = 0.042) but not in controls. In the furosemide group, no patient experienced side effects requiring drug withdrawal. Conclusions. In hypertensive CKD patients treated with RAS inhibitors, add-on furosemide efficaciously reduces LVMI independently from BP changes. The effect is possibly mediated by better control of volume expansion.