Background: There is paucity of literature on use of combination of metolazone and torsemide in patients of type 2 and type 4 cardiorenal syndrome. These patients develop resistance to loop diuretics and fluid overload one of the most important issue. Therefore optimization of diuretic use is crucial for successful management of such patients. We undertook this study to look for efficacy and safety of using metolazone on top of torsemide in patients of type 2 and type 4 cardiorenal syndrome.

Methods: We did retrospective analysis of our patients with type 2 and type 4 cardiorenal syndrome. All of them were started on torsemide 100 mg intravenous bolus and 5 mg metolazone was added later. There hourly urine output , weight loss and BP was recorded. Their demographic data and laboratory parameters were recorded. Appropriate statistics was applied.

Results: We had cohort of 37 patients. They had man age of 56.4±8.5 years. Study population included 22 males and 15 females. There were 54% patients with CRS type 2 and 46% patients with type 4 CRS. 33 patients responded to addition of metolazone. Four patients needed dialysis. Patients had mean weight loss of 2.3± 1.3 kg after 3 days. Hypokalemia was seen in seven patients. Hypotension was also observed in n=2 patients. There was significant increase in urine output. NYHA class also improved in 33 patients.

Conclusion: Combination of metolazone and torsemide was effective and safe in majority of our patients as reflected by increase in urine output and improvement in dyspnea.

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Dr Alok Kumar

Assistant Professor and Head, Department of Nephrology Shri Guru Ram Rai Institute of Medical and Health Sciences Dehradun Uttarakhand, India